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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2014 Jul 1;105(4):e287–e295. doi: 10.17269/cjph.105.4299

Is herpes zoster vaccination likely to be cost-effective in Canada?

Alexander D Peden 1,✉, Stephenson B Strobel 1, Evelyn L Forget 1
PMCID: PMC6972214  PMID: 25166132

Abstract

OBJECTIVES: To synthesize the current literature detailing the cost-effectiveness of the herpes zoster (HZ) vaccine, and to provide Canadian policymakers with cost-effectiveness measurements in a Canadian context.

METHODS: This article builds on an existing systematic review of the HZ vaccine that offers a quality assessment of 11 recent articles. We first replicated this study, and then two assessors reviewed the articles and extracted information on vaccine effectiveness, cost of HZ, other modelling assumptions and QALY estimates. Then we transformed the results into a format useful for Canadian policy decisions. Results expressed in different currencies from different years were converted into 2012 Canadian dollars using Bank of Canada exchange rates and a Consumer Price Index deflator. Modelling assumptions that varied between studies were synthesized. We tabled the results for comparability.

SYNTHESIS: The Szucs systematic review presented a thorough methodological assessment of the relevant literature. However, the various studies presented results in a variety of currencies, and based their analyses on disparate methodological assumptions. Most of the current literature uses Markov chain models to estimate HZ prevalence. Cost assumptions, discount rate assumptions, assumptions about vaccine efficacy and waning and epidemiological assumptions drove variation in the outcomes. This article transforms the results into a table easily understood by policy-makers.

CONCLUSION: The majority of the current literature shows that HZ vaccination is cost-effective at the price of $100,000 per QALY. Few studies showed that vaccination cost-effectiveness was higher than this threshold, and only under conservative assumptions. Cost-effectiveness was sensitive to vaccine price and discount rate.

Key Words: Review, cost-benefit analysis, public policy

Footnotes

Acknowledgement of Sources of Funding: International Centre for Infectious Diseases and Public Health Agency of Canada.

Conflict of Interest: None to declare.

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