Phuc Le, PhD, MPH; Michael B. Rothberg, MD, MPH
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0093.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol: Not applicable. Statistical code: Availability is subject to discussion with the authors. Please contact Dr. Le (e-mail, firstname.lastname@example.org). Data set: Model inputs and sources are explained in the text.
Requests for Single Reprints: Phuc Le, PhD, MPH, Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code G10, Cleveland, OH 44195; e-mail, email@example.com.
Current Author Addresses: Drs. Le and Rothberg: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code G10, Cleveland, OH 44195.
Author Contributions: Conception and design: P. Le, M.B. Rothberg.
Analysis and interpretation of the data: P. Le, M.B. Rothberg.
Drafting of the article: P. Le.
Critical revision of the article for important intellectual content: P. Le, M.B. Rothberg.
Final approval of the article: P. Le, M.B. Rothberg.
Statistical expertise: P. Le, M.B. Rothberg.
Collection and assembly of data: P. Le, M.B. Rothberg.
Le P, Rothberg MB. Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years. Ann Intern Med. 2015;163:489-497. doi: 10.7326/M15-0093
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Published: Ann Intern Med. 2015;163(7):489-497.
Each year, herpes zoster (HZ) affects 1 million U.S. adults, many of whom develop postherpetic neuralgia (PHN). Zoster vaccine is licensed for persons aged 50 years or older, but its cost-effectiveness for those aged 50 to 59 years is unknown.
To estimate the cost-effectiveness of HZ vaccine versus no vaccination.
Adults aged 50 years.
Number of HZ and PHN cases prevented and incremental cost per quality-adjusted life-year (QALY) saved.
For every 1000 persons receiving the vaccine at age 50 years, 25 HZ cases and 1 PHN case could be prevented. The incremental cost-effectiveness ratio (ICER) for HZ vaccine versus no vaccine was $323 456 per QALY.
In deterministic and scenario sensitivity analyses, the only variables that produced an ICER less than $100 000 per QALY were vaccine cost (at a value of $80) and the rate at which efficacy wanes. In probabilistic sensitivity analysis, the mean ICER was $500 754 per QALY (95% CI, $93 510 to $1 691 211 per QALY). At a willingness-to-pay threshold of $100 000 per QALY, the probability that vaccination would be cost-effective was 3%.
Long-term effectiveness data for HZ vaccine are lacking for 50-year-old adults.
Herpes zoster vaccine for persons aged 50 years does not seem to represent good value according to generally accepted standards. Our findings support the decision of the Advisory Committee on Immunization Practices not to recommend the vaccine for adults in this age group.
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Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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