Table 4.
Cost-effectiveness results.
| Author/year | CE outcome | Parameters affecting DSA | PSA runs | PSA results |
|---|---|---|---|---|
| Le and Rothberg (2018)21 | RZV was cost-effective vs no vaccination at all ages; RZV was cost-saving vs ZVL at all ages; RZV was most cost-effective at 70 YOA with an ICER of $20K (USD) |
RZV price per dose; RZV efficacy & waning; PHN incidence (duration over 12 mo); RZV 2nd dose compliance |
10,000 | RZV had between 73% and 91% probability of being cost-effective at a WTP threshold of $50K (USD), and between 78% and 93% probability of being cost-effective at WTP of $100K (USD), depending on vaccination age |
| You et al. (2018)34 | RZV was cost-effective vs no vaccination; RZV was most cost-effective at 70/60 YOA with ICERs of $46.3K/$47.4K (USD) | RZV price per dose; 2-dose RZV efficacy waning; HZ outpatient treatment cost; QALY losses outpatient HZ |
10,000 | RZV had 100% probability of being cost-effective at all ages with a WTP threshold equal to 3 times the GDP per capita; RZV had 60.1%/53.1%/23.9% probability of being cost-effective at 70/60/50 YOA with a WTP threshold equal to the GDP per capita; RZV had 90% probability of being cost-effective at 70/60/50 YOA with WTP thresholds equal to $53.76K/$57.68K/$78.4K (USD) |
| Curran et al. (2018)22 | RZV was cost-effective at all ages vs no vaccination; RZV was cost-saving vs ZVL at 60+ YOA |
RZV efficacy waning (all ages); HZ incidence; Discount rates; 2-dose RZV efficacy waning (≥70 YOA) |
5000 | RZV vaccination at 60+ YOA vs no vaccination had 98%/99.5% probability of being cost-effective below WTP thresholds of $80K/$100K (USD); RZV vaccination at 60+ YOA vs ZVL vaccination at 60+ YOA had a 99% probability of being cost-saving |
| Le and Rothberg (2018b)27 | RZV vaccination with 56.2% second dose compliance was cost-effective vs no vaccination with ICERs below $100K (USD) at 53.2+ YOA and below $50K (USD) at 57.1+ YOA; RZV vaccination with 100% second dose compliance was cost-effective vs no vaccination with ICER below $100K (USD) at approx. 52+ YOA; Revaccination with RZV at 100% series compliance would be cost-effective at 61+ or 71+ YOA given prior ZVL vaccination at 60 or 70 YOA; Revaccination with RZV at 56% series compliance would be cost-effective at 64+ or 74+ YOA given prior ZVL vaccination at 60 or 70 YOA |
PHN incidence; QALY losses; RZV efficacy & waning; RZV price per dose |
10,000 | RZV had 23% probability of being cost-effective at 50 YOA (results for other ages not reported) |
| de Boer et al. (2018)29 | RZV was most cost-effective at 70 YOA with maximum prices at threshold estimated at €54.5/€137.45 at WTP thresholds of €20K/€50K; ZVL was most cost-effective at 60 YOA at a price of €51.37 at the WTP threshold of €20K |
QALY loss HZ; RZV efficacy waning after 4 years; HZ incidence (immunocompetent population) |
10,000 | RZV had over 90% probability of being the most cost-effective option vs no vaccination when vaccine costs per dose were kept below €49.74, €85.8, and €83.64 for 50, 60, and 70 YOA respectively; at 60 YOA, pricing scenarios dictated which vaccine is most cost-effective |
| Van Oorschot et al. (2019)26 | RZV was cost-effective vs no vaccination at 60+ and 70+ YOA; RZV was most cost-effective at 60 and 65 YOA with an ICER of approx. €29.5K |
HZ incidence; PHN incidence (initial); RZV efficacy waning (≥70 YOA); QALY loss unvaccinated case with PHN |
5000 | RZV had 84%/67% probability of being cost-effective at 60+/70+ YOA |
| Curran et al. (2019)23 | RZV revaccination at 60+ YOA was cost-effective vs control previously vaccinated with ZVL (5 years earlier) with an ICER of approx. $59K (USD); RZV revaccination was cost-saving vs ZVL revaccination at 60+ YOA |
RZV efficacy waning; RZV efficacy waning (≥70 YOA); HZ incidence; Discount rates (costs and benefits); Time elapsed between original vaccination and revaccination |
5000 | RZV vaccination vs no revaccination had 75% probability of being cost-effective |
| You et al. (2019)35 | RZV was cost-effective for M and F 50–80 YOA at a price per dose of $80 (USD); RZV was cost-effective for M 54–74 YOA and F 50–79 YOA at a price per dose of $100 (USD); RZV was cost-effective for F 58–72 YOA at a price per dose of $120 (USD) |
Age (M and F); Vaccine cost (M) |
10,000 | RZV had 85.5%/99.7%/99.7%/77% probability of being cost-effective (WTP = 1×GDP per capita) in females 50/60/70/80 YOA; RZV had 57.9%/98.6%/95.6%/26.5% probability of being cost-effective (WTP = 1×GDP per capita) in males 50/60/70/80 YOA |
| Prosser et al. (2019)24 | RZV vaccination vs no vaccination was cost-effective at all ages under the societal perspective with ICERs ranging from $10K to $47K (USD); RZV was most cost-effective at 60+ YOA with an ICER of approx. $19K (USD) under the societal perspective; under the healthcare payer perspective, RZV was most cost-effective at 60+ YOA with an ICER of approx. $29K (USD); RZV revaccination vs control previously vaccinated with ZVL was cost-effective at all age groups under the societal perspective, except for immediate revaccination at 50–59 YOA. ICERs were lower at 80–89 and 70–79 YOA |
Initial RZV efficacy; HZ incidence; PHN incidence; RZV cost per dose; PHN cost; |
10,000 | RZV had 84%/95%/99% probability of being cost-effective at 50-79/60-69/70–99 YOA |
| Shiragami et al. (2019)33 | RZV was cost-effective at 65+ YOA with ICERs of ¥4316K/¥4036K under the payer/societal perspective | RZV efficacy waning (≥70 YOA); PHN incidence; HZ incidence; Vaccine price per dose |
5000 | RZV had 72.2%/79.7% probability of being cost-effective under the payer/societal perspective at a WTP threshold of ¥5 M |
| Hoshi et al. (2019)32 | RZV was marginally cost-effective at 80–84 YOA with an ICER of approx. ¥5.26 M per QALY gained; ZVL was more cost-effective than RZV at all age groups and most cost-effective at 80–84 YOA with an ICER of approx. ¥2.6 M |
RZV price per dose; RZV waning duration (2-dose); QALY losses HZ (with or without PHN) |
1000 | RZV had 43.8% probability of being cost-effective at 65–84 YOA at the WTP threshold of ¥5 M; ZVL had 56.2% probability of being cost-effective at 65–84 YOA at the WTP threshold of ¥5 M |
| Carpenter et al. (2019)25 | RZV was more cost-effective than ZVL at all age groups; RZV was most cost-effective at 70/60 YOA with ICERs of $1.4K/$19.3K (USD) |
1-way: efficacy waning; 2-way: efficacy waning and age of vax |
RZV had 82%/69% probability of being cost-effective at WTP thresholds of $100K/$50K (USD) for all ages (weighed average) | |
| Drolet et al. (2019)20 | RZV was cost-saving or cost-effective at all ages; RZV was more cost-effective than ZVL at all ages; RZV was most cost-effective at 75/70/65 YOA with approx. ICERs of $0.8K/$4.2K/$5.3K (CAD) |
NA | 30,000 | RZV had 75% probability of being cost-effective at all ages ≥60 with a vaccine price per dose of $100 (CAD) |
| McGirr et al. (2019)26 | RZV was cost-effective vs no vaccination at 60+ YOA with an ICER of $28.36K (CAD); RZV was cost-effective vs ZVL with an ICER of $2.4K (CAD) | RZV vs control: 2-dose RZV efficacy waning (≥70 YOA); HZ incidence; PHN incidence (first time) RZV vs ZVL: RZV second dose compliance; 2-dose RZV efficacy waning (≥70 YOA); RZV price per dose |
5000 | RZV had 63.5%/99.2%/100% probability of being cost-effective vs no vaccination at WTP thresholds of $30K/$50K/$100K (CAD); RZV had 100% probability of being cost-effective vs ZVL at the WTP threshold of $50K (CAD), and 48.2% probability of being cost-neutral or cost-saving |
| Curran et al. (2021)28 | RZV was cost-effective at all ages investigated at the revised price of €133.62 per dose and most cost-effective at 50+ YOA with an ICER of €31.7K | HZ incidence; PHN incidence; Annual waning of RZV; QALY loss of unvaccinated HZ case with PHN |
5000 | RZV had a 94%/92.9% probability of being cost-effective at 50+/60+ YOA; at 60+ YOA the maximum RZV price per dose retaining cost-effectiveness below the WTP threshold of €50K was estimated at €163 |
| Pieters et al. (2022)30 | RZV was generally not cost-effective; Under the logarithmic VE model for RZV at a price per dose of €140.26 and at 50 YOA, RZV would only be cost-effective at a WTP threshold of €90K or higher; At 50 YOA the maximum cost-effective price per dose with a WTP threshold of €40K was €55.4 |
RZV price per dose Duration of protection (VE model) |
No explicit ICER acceptability results were discussed | |
| Ortega-Sanchez (2021)18 | RZV was cost-saving in HSCT patients by both models (industry/CDC); RZV was cost-saving in renal transplant patients (industry model) and multiple myeloma (CDC model); RZV was cost-effective in hematologic malignancy and HIV (CDC model) with ICERs of $10K and $79K (USD) respectively; RZV was cost-effective in HIV, breast cancer, and Hodgkin’s lymphoma (industry model) with ICERs of $33K, $68K, and $96K (USD) respectively |
Not elaborated | RZV had a 72% probability of being cost-effective (CDC model); RZV had a 90% probability of being cost-effective and a 50% probability of being cost-saving (industry model) |
|
| Ultsch et al. (2017)19 | RZV was most cost-effective at 60 and 65 YOA with an ICER of approx. €24K; ZVL at 60 YOA was not cost-effective with an ICER exceeding €88K. | Vaccination age; Max duration of protection 5 years, Vaccination costs; PHN incidence; Discounting factors; Recurrent HZ; Baseline utilities |
10,000 | RZV had a 90%/50% probability of being cost-effective at WTP thresholds of €30K/€20K; ZVL had a 90%/50% probability of being cost-effective only at substantially higher WTP thresholds (€110K/€90K) |
CAD: Canadian dollars; CDC: Centers for Disease Control and Prevention; CE: cost-effectiveness; DSA: deterministic sensitivity analysis; GDP: gross domestic product; HIV: human immunodeficiency virus; HSCT: hematopoietic stem cell transplantation; HZ: herpes zoster; ICER: incremental cost effectiveness ratio; K: thousand(s); M/F: male/female; M: million(s); PHN: post-herpetic neuralgia; PSA: probabilistic sensitivity analysis; QALY: quality-adjusted life year; RZV: recombinant zoster vaccine; US: United States; USD: US dollars; VE: vaccine efficacy; WTP: willingness to pay; YOA: years of age; ZVL: zoster vaccine live.