Background: Herpes zoster (HZ), or shingles, results from reactivation of latent varicella zoster virus in the sensory ganglia of adults, and results in significant morbidity in the elderly, including the development of postherpetic neuralgia (PHN). The lifetime risk of HZ is about 20–30% and the incidence increases with age. The protective effect of the HZ vaccine has been shown in a large clinical trial; however, the effectiveness of the vaccine decreased with age of vaccination.
Objective: We sought to compare the incremental cost and health benefits of HZ vaccine over status quo (no HZ vaccine) from the perspective of the Canadian healthcare payer.
Methods: We developed a discrete-event simulation model comparing the costs and QALYs accrued to patients receiving HZ vaccine to those who did not. The effect of the vaccine on the (i) incidence of severe, moderate or mild HZ; (ii) severity and duration of HZ; (iii) incidence of PHN among patients with HZ; (iv) duration of PHN; and (v) costs associated with treating HZ and PHN were modelled. Data from published literature, including the Shingle Prevention Study, were used for transition probabilities. Health resource utilizations were estimated using administrative data retrieved from the British Columbia Medical Services Plan and hospital separation databases in British Columbia from 1994 to 2003. Utility estimates were obtained from various published sources. Canadian 2008 costs were used and both cost and QALYs were discounted at a 5% annual rate in the base-case analyses.
Results: On average, receiving the vaccination lowered mean direct medical costs (excluding the vaccine costs) by $Can35 per person. The incremental cost and QALYs per person receiving the vaccine versus no vaccination were $Can115 and 0.0028 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $Can41 709 per QALY gained for a cohort of elderly subjects aged ≥60 years. Results were robust in probabilistic and univariate sensitivity analyses. Expected value of perfect information was estimated at $Can47.72 per person, reflecting the expected monetary losses that could be avoided by having perfect information on all model parameters.
Conclusion: HZ vaccination of adults, especially for individuals aged 60–75 years, seems to be a cost-effective intervention and might be considered by Canadian decision makers.
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This study was part of work done by Carlo Marra as a consultant to the British Columbia Centre for Disease Control to evaluate the cost effectiveness of herpes zoster vaccine in British Colombia. The authors have no conflicts of interest that are directly relevant to the content of this study.
Brisson M, Edmunds WJ, Law B, et al. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect 2001; 127: 305–14PubMedCrossRefGoogle Scholar
Edgar BL, Galanis E, Kay C, et al. The burden of varicella and zoster in British Columbia 1994-2003: baseline assessment prior to universal vaccination. Can Commun Dis Rep 2007; 33: 1–15PubMedGoogle Scholar
Pellissier JM, Brisson M, Levin MJ. Evaluation of the costeffectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Vaccine 2007; 25: 8326–37PubMedCrossRefGoogle Scholar
Oster G, Harding G, Dukes E, et al. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain 2005; 6: 356–63PubMedCrossRefGoogle Scholar
Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352: 2271–84PubMedCrossRefGoogle Scholar
Brisson M, Van de Velde N, De Wals P, et al. The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine 2007; 25: 5399–408PubMedCrossRefGoogle Scholar
De Wals P, Coudeville L, Trottier P, et al. Vaccinating adolescents against meningococcal disease in Canada: a cost-effectiveness analysis. Vaccine 2007; 25: 5433–40PubMedCrossRefGoogle Scholar
Levin MJ, Barber D, Goldblatt E, et al. Use of a live attenuated varicella vaccine to boost varicella-specific immune responses in seropositive people 55 years of age and older: duration of booster effect. J Infect Dis 1998; 178: S109–12CrossRefGoogle Scholar
Edmunds WJ, Brisson M, Rose JD. The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales. Vaccine 2001; 19: 3076–90PubMedCrossRefGoogle Scholar
Johnson JA, Pickard AS. Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Med Care 2000; 38: 115–21PubMedCrossRefGoogle Scholar
Petrou S, Hockley C. An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ 2005; 14: 1169–89PubMedCrossRefGoogle Scholar
Brisson M, Pellissier JM, Camden S, et al. The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia. Hum Vaccin. Epub 2008 Jan 25; 4 (3)Google Scholar
McDonough CM, Grove MR, Tosteson TD, et al. Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among spine patient outcomes research trial (SPORT) participants. Qual Life Res 2005; 14: 1321–32PubMedCrossRefGoogle Scholar
Hornberger J, Robertus K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Int Med 2006; 145: 317–25PubMedGoogle Scholar
Dworkin RH, White R, O’Connor AB, et al. Healthcare costs of acute and chronic pain associated with a diagnosis of herpes zoster. J Am Geriatr Soc 2007; 55: 1168–75PubMedCrossRefGoogle Scholar
Regier DA, Sunderji R, Lynd LD, et al. Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy. CMAJ 2006; 174: 1847–52PubMedCrossRefGoogle Scholar
Balen RM, Marra CA, Zed PJ, et al. Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute coronary syndromes: a Canadian hospital perspective. Pharmacoeconomics 1999; 16 (5 Pt 2): 533–42PubMedCrossRefGoogle Scholar
Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Clin Infect Dis 2007; 44: 1280–8PubMedCrossRefGoogle Scholar
Halpern EF, Weinstein MC, Hunink MG, et al. Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients. Med Decis Making 2000; 20: 314–22PubMedCrossRefGoogle Scholar
Brennan A, Kharroubi S, O’Hagan A, et al. Calculating partial expected value of perfect information via Monte Carlo sampling algorithms. Med Decis Making 2007; 27: 448–70PubMedCrossRefGoogle Scholar
Sadatsafavi M, Najafzadeh M, Bansback N, et al. A novel method for the calculation of the expected value of partial perfect information. 30th Annual Meeting of the Society for Medical Decision Making; 2008 Oct 19–22; PhiladelphiaGoogle Scholar
Hammerschmidt T, Goertz A, Wagenpfeil S, et al. Validation of health economic models: the example of EVITA. Value Health 2003; 6: 551–9PubMedCrossRefGoogle Scholar
Goldman GS. Cost-benefit analysis of universal varicella vaccination in the U.S. taking into account the closely related herpes-zoster epidemiology. Vaccine 2005; 23: 3349–55PubMedCrossRefGoogle Scholar
Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child 2003; 88: 862–9PubMedCrossRefGoogle Scholar