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Cost-Effectiveness Analysis of Herpes Zoster Vaccination in 50- to 85-Year-Old Immunocompetent Belgian Cohorts: A Comparison between No Vaccination, the Adjuvanted Subunit Vaccine, and Live-Attenuated Vaccine

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A Letter to the Editor to this article was published on 26 September 2022

Abstract

Background

A new adjuvanted subunit vaccine (HZ/su), with higher vaccine efficacy than live-attenuated vaccine (ZVL), has been licensed in Europe since March 2018. Therefore, Belgian decision-makers might need to re-assess their recommendations for vaccination against herpes zoster (HZ).

Methods

We conducted a cost-effectiveness analysis, using a Markov decision tree, of vaccinating 50- to 85-year-old immunocompetent Belgian cohorts with no vaccination, HZ/su, ZVL, and ZVL with booster after 10 years. Due to the uncertainty in vaccine waning of HZ/su vaccine beyond 4 years, we used a logarithmic and 1-minus-exponential function to model respectively a long and short duration of protection. We used a lifetime time horizon and implemented the health care payer perspective throughout the analysis.

Results

HZ/su had the greatest impact in avoiding health and economic burden. However, it would never become cost-effective at a willingness-to-pay threshold of €40,000 per quality-adjusted life year (QALY) gained at its market price set by the manufacturer in the USA. Depending on the waning function assumed for HZ/su, the price per dose needs to drop 60% or 83% such that vaccination with HZ/su, assuming respectively a long or short duration of protection, would become cost-effective in 50- and 80-year-old individuals. At €40,000 per QALY gained, ZVL or ZVL with booster was never found cost-effective compared with HZ/su, even if only administration cost was considered.

Conclusion

HZ/su is cost-effective in the 50-year-old age cohort at the unofficial Belgian threshold of €40,000 per QALY gained, if its price drops to €55.40 per dose. This result is, however, very sensitive to the assumed duration of protection of the vaccine, and the assumed severity and QALY loss associated with HZ and post-herpetic neuralgia (PHN).

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Acknowledgements

We would like to thank the colleagues from the SIMID group for their input during our monthly meetings.

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Authors and Affiliations

  1. I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium

    Zoë Pieters

  2. Centre for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Benson Ogunjimi, Philippe Beutels & Joke Bilcke

  3. Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing (AUDACIS), Antwerp, Belgium

    Benson Ogunjimi

  4. Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium

    Benson Ogunjimi

  5. Antwerp Centre for Translational Immunology and Virology (ACTIV), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium

    Benson Ogunjimi

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Corresponding author

Correspondence to Joke Bilcke.

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Author Contributions

P.B. and J.B. conceived the study. Z.P. performed the analyses and wrote the first draft. B.O. commented on the choices made in the input data. All authors read and approved the final version for publication.

Funding

This work was supported in part by Research Foundation-Flanders (JB), the Methusalem financing program of the Flemish government (ZP). The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report.

Conflict of interest

In 2019, P.B. participated in four half-day meetings organised by Pfizer Belgium. These meetings led to the development of a summary paper that was published in 2020 (Annemans et al., Value in Health 2020). For his participation, the University of Antwerp received compensation. P.B. received no personal fee for his participation. The University of Antwerp received grant money from the European Commission’s IMI programme (RESCEU; 2017–2021) to fund research on RSV conducted in The Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), which P.B. heads. The IMI programme involves many pharmaceutical companies in a public–private partnership. CHERMID also collaborated with the Centre for the Evaluation of Vaccination on a study on pneumococcal carriage in children (2015–2019), and that study was supported by a grant from Pfizer. In the period 2009–2019, the University of Antwerp received for its part-time “chair in evidence-based vaccinology” unrestricted grants from Pfizer and GSK. P.B. is promotor of the chair, but not the chair holder. By definition, the research agenda supported by the chair holder is determined and executed completely independent from the sponsors. The chair is no longer supported by private sponsors since January 2020.

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All data are presented within the main text or Appendix. Data files are also implemented in the R model, which is available upon request.

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Pieters, Z., Ogunjimi, B., Beutels, P. et al. Cost-Effectiveness Analysis of Herpes Zoster Vaccination in 50- to 85-Year-Old Immunocompetent Belgian Cohorts: A Comparison between No Vaccination, the Adjuvanted Subunit Vaccine, and Live-Attenuated Vaccine. PharmacoEconomics 40, 461–476 (2022). https://doi.org/10.1007/s40273-021-01099-2

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