Cost-effectiveness of Recombinant Zoster Vaccine (RZV) and Varicella Vaccine Live (VVL) against herpes zoster and post-herpetic neuralgia among adults aged 65 and over in Japan |
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| Institution: | 1. Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan;2. Department of Environmental Engineering, Environmental Health Division, Kyoto University, Nishikyo-ku, Kyoto 6158246, Japan;3. Department of Public Health and Epidemiology, Faculty of Pharmaceutical Sciences, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 2048588, Japan;4. Yokohama City Institute of Public Health, 7-1, Tomiokahigashi 2-chom, Kanazawa-ku, Yokohama City 236-0051 Japan;1. Global Health Outcomes, Merck & Co., Inc., West Point, PA, USA;2. Department of Market Access and Economics, Sanofi Pasteur MSD, France;1. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO, United States;2. Division of General Internal Medicine, Denver Health, Denver, CO, United States;3. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States;4. Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;5. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States;6. Office of the Associate Director for Communication, Centers for Disease Control and Prevention, Atlanta, GA, United States;1. GSK, US Health Outcomes & Epidemiology, Philadelphia, PA;2. GSK, Global Health Economics, Wavre, Belgium;3. RTI Health Solutions, Health Economics, Research Triangle, NC;1. Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;2. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK;3. Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London, UK;1. Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL;2. Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL;3. Auburn University Harrison School of Pharmacy, Auburn, AL |
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| Abstract: | BackgroundThe approval of the extended use of 1-dose varicella vaccine (VVL) in adults aged 50 and older against herpes zoster (HZ) in 2016 and the 2-dose recombinant zoster vaccine (RZV) in 2018 raised the need to evaluate the value for money between these two vaccines.MethodsWe conducted a cost-effectiveness analysis with Markov modelling to evaluate the efficiency of the immunisation programmes from payer’s perspective. Eight strategies with different ages to receive VVL or RZV were set, namely: 65–84 year old (y.o.), 70–84 y.o., 75–84 y.o., and 80–84 y.o. VVL- or RZV-strategy. Incremental cost-effectiveness ratios (ICERs) compared with curative care scenario were calculated. The health statuses following the target cohort were as follows: acute HZ followed by recovery, post-herpetic neuralgia followed by recovery, post HZ/PHN, recurrence of HZ, and general death.ResultsAt the vaccination cost ¥8000 (US$73) for 1-dose ZVL and ¥30,000 (US$273) for 2-dose RZV, ICERs ranged from ¥2,633,587/US$23,942 (age 80–84 y.o.) to ¥3,434,267 or US$31,221 (age 65–84 y.o.)/QALY gained for VVL-strategies; from ¥5,262,227 or US$47,838 (age 80–84 y.o.) to ¥6,278,557 or US$57,078/QALY gained (age 65–84 y.o.) for RZV-strategies. Cost-effectiveness acceptability curves derived from probabilistic sensitivity analyses showed that if the cost-effective threshold was at ¥3,000,000 or US$27,273/QALY, the acceptability was 90.7% and 8.8% for 65–84 VVL-strategy and 65–84 RZV-strategy, respectively; if at ¥5,000,000 or US$45,455/QALY, 56.2% and 43.8%, and if at ¥10,000,000 or US$90,909/QALY 11.9% and 88.1%, respectively.ConclusionVaccinating individuals aged 65–84 y.o., 70–84 y.o., 75–84 y.o., 80–84 y.o. with VVL or RZV to prevent HZ-associated disease in Japan can be cost-effective from payer’s perspective, with vaccination costs at ¥8,000 per shot for VVL, ¥30,000 for 2-dose RZV. While the results suggesting that only 65–84 VVL-strategy and 65–84 RZV strategy should be considered when introducing HZ immunisation programme. The optimal strategy varies depending on the willingness-to-pay threshold. |
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| Keywords: | Cost-effectiveness Economic evaluation Herpes zoster Varicella vaccine Vaccination Quality-adjusted life year |
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