Which Herpes Zoster Vaccine is Most Cost-Effective?

Is the adjuvanted herpes zoster subunit vaccine cost-effective?

That is the question a new research study addressed in the JAMA Internal Medicine, January 2018.

This study reported the new shingles vaccine is expensive but worth the price.

There are two FDA approved herpes zoster vaccines:

• The live attenuated herpes zoster vaccine is recommended for immunocompetent adults 60+ years old, but the efficacy has been reported to diminish over time.
• A newly approved adjuvanted herpes zoster subunit vaccine has been reported with higher efficacy, but might be more expensive.

The choice of vaccines depends on their relative values, say these researchers.

In this modeling study based on randomized clinical trial data, at the proposed price of $280 per 2-dose course, the adjuvanted herpes zoster subunit vaccine (HZ/su) was found to be more effective and less expensive, than the live attenuated herpes zoster vaccine (ZVL).

At the current ZVL price ($213 per dose), HZ/su had lower overall costs than ZVL up to a price of $350 per 2-dose series.

In probabilistic sensitivity analysis, HZ/su had 73% probability of being cost-effective for people 60-years-old.

The incremental cost-effectiveness ratio was sensitive to the vaccine price and certain combinations of low adherence rate with a second dose and low efficacy of a single dose of the adjuvanted herpes zoster subunit vaccine.

Herpes zoster affects almost 1 in 3 adults in the United States during their lifetime. The disease often causes severe pain that may last for a few weeks. Some patients continue to experience debilitating pain for more than a year, a complication that is known as postherpetic neuralgia (PHN).

The HZ incidence increases sharply with age.

For example, the incidence is 4.6 cases per 1,000 person-years in those who are aged 50 to 59 years, and the rate increases to 10.3 cases per 1,000 person-years in those who are 80 years or older, reports Mehdi Najafzadeh, Ph.D. 

During October 2017, the US Food and Drug Administration has approved Shingrix (Zoster Vaccine Recombinant, Adjuvanted) for the prevention of shingles/herpes zoster in adults aged 50 years and older. Shingrix is a non-live, recombinant subunit vaccine given intramuscularly in two doses.

Dr. Thomas Breuer, Chief Medical Officer of GSK Vaccines said: “Shingrix has shown over 90% efficacy across all age groups in the prevention of shingles. Shingrix was developed specifically to overcome the age-related decline in immunity.”

Previously, the Centers for Disease Control and Prevention (CDC) recommended a single dose of herpes zoster vaccine (Zostavax) for people 60 years old or older, whether or not the person reported a prior episode of zoster. Zostavax is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, such as influenza and pneumococcal vaccines.

Most pharmacies offer shingles vaccines. The retail price of this vaccine varies based upon insurance coverage and location.

Vaccine discounts can be found here.

Vaccines, like any medicine, can have side effects, says the CDC. You are encouraged to report negative side effects of vaccines to the FDA or CDC.

Author Affiliations: Phuc Le, Ph.D., MPH; Michael B. Rothberg, MD, MPH, both with the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.