Table 1. Main characteristics and results of the included studies.
| Reference; country | Type of analysis | Model design; Alternatives |
Perspective | Targeted population: Vaccination age in years (range) | Time Horizon | Currency year; Discount rate |
Sensitivity analysis | Cost-effectiveness results, ICER (cost per QALY gained) (Short description of the studies in Appendix B) | Funding |
|---|---|---|---|---|---|---|---|---|---|
| Edmunds et al. (2000);34 England and Wales |
CUA, CEA | DA model; HZ vaccination vs. no vaccination |
Health Care provider | 65 (45–80) | Lifetimea | £ (1998); C: 3% E: 3% |
One-way, multi-way | £8684 for a 65 y old assuming 10 y protection and £3560 assuming lifelong protection (£80 per vaccine course). | Public |
| Hornberger et al. (2006)35; USA | CUA | DA model; HZ vaccination vs. no vaccination |
Society | ≥ 60, median age 69 (60–85) | Lifetime | US$ (1995); C: 3% E: 3% |
One-way, multi-way, PSA |
Cost-effective ($50,000 threshold) if vaccine price is $100 and duration of vaccine protection is at least 20 y. | No funding |
| Pellissier et al. (2007)36; USA | CUA, CEA | DA model; HZ vaccination vs. no vaccination |
Health Care payer and Society | ≥ 60 (60–85) | Lifetime | US$ (2006); C: 3% E: 3% |
One-way, PSA |
$18,439–27,609 from payer’s perspective and $16,229–25,379 from societal perspective depending on input data source and assuming lifelong vaccine efficacy (vaccine price: $168). Cost-effective below threshold of $50,000 when vaccine duration of efficacy is at least 12 y. | Industry |
| Rothberg et al. (2007)37; USA | CUA | DA model; HZ vaccination vs. no vaccination |
Society | ≥ 60 (60–69, ≥ 70) | Lifetimea | US$ (2005); C: 3% E: 3% |
One-way, multi-way | $44,000 for a 70-y-old woman to $191,000 for a 80-y-old man (10 y duration of vaccine efficacy and vaccine price of $149). Cost-effective below threshold of $50,000 for all adults ≥ 60 if vaccine cost of $46. | Public |
| Brisson et al. (2008);38 Canada |
CUA | DA model; HZ vaccination vs. no vaccination |
Health Care provider | 65 (50- 80) | Lifetime | Can$ (2005); C: 5% E: 5% |
One-way, PSA |
Can$1277 to Can$73,609, depending on age and vaccine cost, assuming lifelong vaccine efficacy. Vaccinating between 60–75 y is likely cost-effective below Can$40,000 threshold if duration of vaccine efficacy is at least 22 y (vaccine cost Can$150) | Industry |
| Najafzadeh et al. (2009);39 Canada |
CUA | DES model; HZ vaccination vs. no vaccination |
TPP | > 60 (60–74; > 75) | Lifetime | Can$ (2008); C: 5% E: 5% |
One-way, PSA |
Can$41,709 for vaccinating age-group > 60 y, assuming vaccine cost of Can$150 and a vaccine efficacy half-life of 15 y. When vaccine cost is higher than Can$150, the ICER increases above threshold of Can$50,000. | Public |
| Van Hoek et al. (2009);40 England and Wales |
CUA | DA model; HZ vaccination vs. no vaccination |
Health Care provider | 60, 65, 70, 75 | Lifetimea | £ (2006); C: 3.5% E: 3.5% |
One-way, PSA | Between £15,146 and £26,705 depending on age if duration of protection is 7.5 y and vaccination costs are £65. Vaccine cost allowed to increase to £90-£100 to hold cost-effectiveness below £30,000 threshold. | Public |
| Annemans et al. (2010);41 Belgium |
CUA, CEA | DA model; HZ vaccination vs. no vaccination |
TPP, Health Care payer and Society | ≥ 60 (≥ 50, ≥ 65, 60–64, 65–69, 60–69) | Lifetime | € (2007); C: 3% E: 1.5% |
One-way, PSA |
€6799 (TPP), €7168 (health care) and €7137 (societal) for elderly aged ≥ 60 y, assuming lifelong vaccine efficacy and vaccine cost of €141. One-way sensitivity analyses showed ICERs of €4,959–19,052, all below unofficial cost-effectiveness threshold of €30,000. | Industry |
| Moore et al. (2010)42; UK | CUA, CEA | DA model; HZ vaccination vs. no vaccination |
NHS and Society | > 50 (50- ≥ 100 in 5-y age-groups) | Lifetime | £ (2006); C: 3.5% E: 3.5% |
One-way, PSA |
£13,077 (NHS) and £11,417 (societal) for vaccinating elderly aged ≥ 50 y, assuming lifelong vaccine efficacy and vaccine cost of £105. Duration of vaccine efficacy has to exceed 10 y to remain cost-effective (£30,000 threshold). | Industry |
| Van Lier et al. (2010)43; The Netherlands | CUA | DA model; HZ vaccination vs. no vaccination |
Society and Health Care payer | 60, 65, 70, 75, 80 | Lifetimea | € (2008); C: 4% E: 1.5% |
One-way, PSA |
Societal: €21,716–38,519 depending on age, assuming duration of vaccine efficacy of 7.5 y and vaccine cost of €83. Healthcare: €40,503 (age 60 y). Cost-effective for all vaccination ages except 80 y, if duration of vaccine efficacy was 16.1 y (€20,000 threshold). | Publica |
| Szucs et al. (2011);44 Switzerland |
CUA, CEA | DA model; HZ vaccination vs. no vaccination |
TPP and Society | 70–79 (60–69, ≥ 65, ≥ 75) | Lifetime | CHF (NA); C: 3.5% E: 1.5% |
One way | CHF25,538 (€16,390) from TPP and CHF28,544 (€18,320) from societal perspective for 70–79 y olds, assuming lifelong vaccine efficacy and vaccine cost of CHF266 (€171). A 12 y duration of vaccine efficacy resulted in an ICER of CHF31,553 (€20,251), below unofficial threshold of €30,000. | Industry |
| Bilcke et al. (2012);45 Belgium |
CUA, CEA | DA model; HZ vaccination vs. no vaccination |
Health Care payer | 60, 70, 80, 85 | Lifetime | € (NA); C: 3% E: 1.5% |
One-way, Multi-way |
€1251–5498 most in favor and €45,160–297,141 least in favor of vaccination depending on age and assuming vaccine cost of €112. Vaccination cost needs to decrease below €67 to be cost-effective among all scenarios (unofficial threshold of €30,000) | Public |
| Bresse et al. (2013);46 France |
CUA, CEA | DA model; HZ vaccination vs. no vaccination |
TPP and Health Care payer | 70–79, ≥ 65 | Lifetime | € (1998); C: 4%b E: 4%b |
One-way, PSA |
€9513 from TPP and €14,198 from societal perspective (70–79 y olds), assuming 10 y duration of vaccine protection and vaccine cost of €125. | Industry |
| De Boer et al. (2013)47; The Netherlands | CUA | DA model; HZ vaccination vs. no vaccination |
Society and Health Care payer | 60, 65, 70, 75 | Lifetime | € (2010); C: 4% E: 1.5% |
One-way | €29,664–35,555 from societal and €29,881–42,004 from health care payer’s perspective, depending on age and assuming 12 y protection and vaccine cost of €93. Vaccination was cost-effective for 60 to 75 y-olds, using €50,000 threshold. When €20,000 threshold was applied, vaccination was only cost-effective assuming lifelong duration of vaccine protection | No funding |
C: costs, Can$: Canadian dollar, CEA: Cost-effectiveness analysis, CHF: Swiss franc, CUA: Cost-utility analysis, DA: Decision analytic, DES: Discrete event simulation, E: effects, HZ: Herpes Zoster, NA: Not available, NHS: National Health Service, TPP: Third-party payer; a: Not clearly stated, assumed by the authors, b: 2% after 30 y