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Cost-Effectiveness of Herpes Zoster Vaccine

The influences of numerous variables remain difficult to gauge, but current evidence supports use of the vaccine.

Herpes zoster imposes a significant burden of illness on older adults, particularly because approximately one third of zoster patients over age 60 experience chronic pain — so-called postherpetic neuralgia (PHN). A recent randomized, double-blind, placebo-controlled trial of zoster vaccine in more than 38,500 adults showed relative-risk reductions of 51% and 67% for the development of zoster and PHN, respectively (the Shingles Prevention Study; see Journal Watch Infectious Diseases Jun 22 2006). The FDA has recommended that all immunocompetent people age 60 and older should receive the zoster vaccine. The costs and benefits must be weighed before widespread vaccination programs are implemented.

Hornberger and Robertus used data from the Shingles Prevention Study to estimate the cost-effectiveness of zoster vaccine. Assuming a vaccine cost of $200 and 12-year duration of vaccine efficacy, the cost per quality-adjusted life year (QALY) was $159,375. With the now-set vaccine cost of $150, the cost per QALY is probably close to $100,000, a commonly accepted cutoff for cost-effectiveness, as noted in an accompanying editorial. In sensitivity analyses, cost-effectiveness varied greatly with the age of vaccine recipients, vaccine cost, quality-of-life adjustments, and duration of vaccine efficacy. The editorialist suggests that the cost-effectiveness of the vaccine remains to be definitively estimated and that coverage decisions will for now be based on "willingness to pay."

Comment: These results reveal the uncertainty often inherent in economic analyses of clinical trials. The duration of zoster vaccine efficacy remains to be determined, and the effect of widespread childhood immunization against varicella zoster virus on the incidence of zoster in older adults is unknown. If the lifetime incidences of zoster and PHN decrease as much after vaccination in clinical practice as they did during the 3 years of the Shingles Prevention Study, I would agree with the editorialists that denying zoster vaccination to immunocompetent elderly patients will be difficult.

— Adam Gilden Tsai, MD

Dr. Tsai is Instructor of Medicine, University of Pennsylvania School of Medicine, and Staff Physician, Philadelphia VA Medical Center.

Published in Journal Watch Neurology October 24, 2006

Citation(s):

Hornberger J and Robertus K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006 Sep 5; 145:317-25.

• Original article (Subscription may be required)
• Medline abstract (Free)

Koplan JP and Harpaz R. Shingles vaccine: Effective and costly or cost-effective? Ann Intern Med 2006 Sep 5; 145:386-7.

• Original article (Subscription may be required)
• Medline abstract (Free)