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Cost-Effectiveness of a Vaccine To Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults

John Hornberger, MD, MS; and Katherine Robertus, MPH
[+] Article, Author, and Disclosure Information

From the SPHERE Institute and Acumen LLC, Burlingame, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Stanford University School of Medicine, Stanford, California.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: John Hornberger, MD, MS, Acumen LLC, 500 Airport Boulevard, Suite 365, Burlingame, CA 94010; e-mail, jhornberger@acumen-llc.com.

Current Author Addresses: Dr. Hornberger and Ms. Robertus: Acumen LLC, 500 Airport Boulevard, Suite 365, Burlingame, CA 94010.

Author Contributions: Conception and design: J. Hornberger.

Analysis and interpretation of the data: J. Hornberger, K. Robertus.

Drafting of the article: J. Hornberger.

Critical revision of the article for important intellectual content: J. Hornberger, K. Robertus.

Final approval of the article: J. Hornberger, K. Robertus.

Provision of study materials or patients: J. Hornberger.

Statistical expertise: J. Hornberger, K. Robertus.

Obtaining of funding: J. Hornberger.

Administrative, technical, or logistic support: J. Hornberger.

Collection and assembly of data: J. Hornberger, K. Robertus.

Ann Intern Med. 2006;145(5):317-325. doi:10.7326/0003-4819-145-5-200609050-00004
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We constructed a decision theoretical model with Microsoft Office Excel 2003 and Microsoft Visual Basic 6.3 software (Microsoft Corp., Redmond, Washington) to compare the clinical and economic effects of VZV vaccination with those of no vaccination in older adults (Figure 1). At a given time, a patient may be in one of a finite number of health states. Events are modeled as transitions from one state to another. For each state, a utility is assigned as an adjustment factor for quality of life. Utility weights typically range from 0 to 1, in which 0 represents a state as bad as death, 1 represents perfect health, and values between 0 and 1 represent states between these extremes. The contribution to total utility, commonly called quality-adjusted life-years (QALYs), of a particular state consists of the length of time spent in a state multiplied by the utility of that state.

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Figure 1.
Markov state transition model.

A patient occupies a tunnel state (white boxes) for 1 cycle only. Curved arrows denote death. The effect of herpes zoster on burden of illness in the model reflects the findings of the Shingles Prevention Study (6). PHN = postherpetic neuralgia.

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Figure 2.
Cost per quality-adjusted life-year (QALY) gained as a function of duration of vaccine efficacy (from 3 to 30 years) and total vaccination costs (from $50 to $500).

Total vaccination costs include unit vaccine cost, a public awareness campaign, administration costs, patient travel time and time receiving vaccine, and cost of treating adverse events.

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Figure 3.
One-way sensitivity analysis.

The effect of varying input variables on incremental cost-effectiveness ratios (cost per quality-adjusted life-year [QALY] ratios) for vaccination versus no vaccination. Bars indicate the variability in the cost-effectiveness ratio associated with changes in the indicated input variables. The values in parentheses show the source for the base-case value and plausible ranges. The dotted line shows the cost per QALY when vaccine cost is $200, duration of vaccine efficacy is 30 years, and all other input variables are placed at their base-case values. PHN = postherpetic neuralgia.

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Appendix Figure 1.
Correlation of herpes zoster–specific burden-of-illness score with utilities.

Data presented are means (SDs). The range for burden-of-illness score is 0 to 1813. Data are from Coplan et al. (9). VAS = visual analogue scale.

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Appendix Figure 2.
Probabilistic sensitivity analyses by vaccine cost (top), age (middle), and duration of vaccine efficacy (bottom).

ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life-year.

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Summary for Patients

Cost-Effectiveness of a Vaccine To Prevent Herpes Zoster (Shingles) in Older Adults

The summary below is from the full report titled “Cost-Effectiveness of a Vaccine To Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults.” It is in the 5 September 2006 issue of Annals of Internal Medicine (volume 145, pages 317-325). The authors are J. Hornberger and K. Robertus.


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