Table 2.
Cost and QALY outcomes for RZV versus no vaccine for US adults IC due to HSCT (base case) and other conditions (Scenarios A–D)
| Base casea | |||
|---|---|---|---|
| RZV | No vaccine | Incremental (RZV vs. no vaccine) | |
| Total societal cost (US$)a | 21,355,313 | 21,461,730 | −106,417 |
| Direct costs due to HZ (US$) | 9,360,330 | 18,956,241 | 9,595,9110 |
| Indirect costs due to HZ (US$) | 2,016,822 | 2,505,489 | 488,666 |
| Vaccination costs (US$) | 9,978,160 | NA | NA |
| QALYs | 213,289 | 213,180 | 109 |
| ICER (US$ per QALY gained) | NA | NA | Cost saving |
| Scenario analysesb | ||||||||
|---|---|---|---|---|---|---|---|---|
| Scenario A: HIV population | Scenario B: Breast cancer population | Scenario C: Hodgkin’s lymphoma population | Scenario D: Renal transplant population | |||||
| RZV | No vaccine | RZV | No vaccine | RZV | No vaccine | RZV | No vaccine | |
| Total societal cost (US$, millions) | 663.4 | 551.2 | 196.7 | 162.4 | 5.5 | 3.8 | 37.3 | 43.0 |
| Direct costs due to HZ (US$, millions) | 140.0 | 526.2 | 33.2 | 103.7 | 0.8 | 3.0 | 24.9 | 41.1 |
| Indirect costs due to HZ (US$, millions) | 6.6 | 24.9 | 21.9 | 58.8 | 0.4 | 0.7 | 1.2 | 1.9 |
| Vaccination costs (US$, millions) | 516.8 | 0 | 141.6 | 0 | 4.3 | 0 | 11.2 | 0 |
| Total societal cost difference [RZV vs. no vaccine] (US$, millions) | 112.2 | 34.2 | 1.7 | −5.8 | ||||
| Incremental QALYs gained (RZV vs. no vaccine) | 3373 | 506 | 18 | 156 | ||||
| ICER (US$ per QALY gained) | 33,268 | 67,682 | 95,972 | Cost saving | ||||
HIV human immunodeficiency virus, HSCT hematopoietic stem cell transplant, HZ herpes zoster, IC immunocompromised, ICER incremental cost-effectiveness ratio, NA not applicable, QALY quality-adjusted life year, RZV recombinant zoster vaccine, US United States
aAll outcomes are discounted. Population size: 19,671
bHIV scenario population size: 1,018,846; breast cancer scenario population size: 279,100; Hodgkin’s lymphoma scenario population size: 8480; renal transplant scenario population size: 22,106. See electronic supplementary Table A8 for more detail