Lisa A. Prosser, PhD; Rafael Harpaz, MD, MPH; Angela M. Rose, MPH; Acham Gebremariam, MS; Angela Guo, MPH; Ismael R. Ortega-Sanchez, PhD; Fangjun Zhou, PhD; Kathleen Dooling, MD, MPH
Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Acknowledgment: The authors thank the following expert panel for feedback on modeling assumptions: Edward Belongia, MD; Paul Cieslak, MD; Jeffrey A. Kelman, MMSc, MD; and Kelly Moore, MD, MPH. They also thank the ACIP Zoster Work Group and internal economic peer reviewers at the CDC for review and feedback and Nicole Elmblad and Dietta Chihade, MSc, for research assistance. They acknowledge Michael Harvey's earlier research on the burden of zoster illness, which informed development of parameter inputs.
Financial Support: By contract 200-2016-M-89909 from the CDC.
Disclosures: Dr. Prosser reports research funding from the CDC during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2347.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive 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. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: A protocol was not published before initiation of the study. The article and Supplement are designed to provide sufficient information for an interested reader to replicate the analysis. Statistical code: Available from Dr. Prosser (e-mail, email@example.com). Data set: Not applicable. This study did not use an analytic data set but used simulated data generated via the simulation model.
Corresponding Author: Lisa A. Prosser, PhD, University of Michigan, 300 North Ingalls Street, 6A14, Ann Arbor, MI 48109; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Prosser: University of Michigan, 300 North Ingalls Street, 6A14, Ann Arbor, MI 48109.
Dr. Harpaz: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Building 24, Atlanta, GA 30333.
Ms. Rose: University of Michigan, 300 North Ingalls Street, Ann Arbor, MI 48109.
Mr. Gebremariam: University of Michigan, 300 North Ingalls Street, 6E6, Ann Arbor, MI 48109.
Ms. Guo: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-34, Atlanta, GA 30333.
Dr. Ortega-Sanchez: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road NE, Mailstop H24-5, Atlanta, GA 30333.
Dr. Zhou: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Building 24, Mailstop A-19, Atlanta, GA 30333.
Dr. Dooling: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Building 24, Office 5211, Mailstop A-34, Atlanta, GA 30333.
Author Contributions: Conception and design: L.A. Prosser, R. Harpaz, A. Guo, I.R. Ortega-Sanchez, K. Dooling.
Analysis and interpretation of the data: L.A. Prosser, R. Harpaz, A. Gebremariam, I.R. Ortega-Sanchez, F. Zhou.
Drafting of the article: L.A. Prosser, R. Harpaz.
Critical revision of the article for important intellectual content: L.A. Prosser, R. Harpaz, A. Gebremariam, I.R. Ortega-Sanchez, K. Dooling.
Final approval of the article: L.A. Prosser, R. Harpaz, A.M. Rose, A. Gebremariam, A. Guo, I.R. Ortega-Sanchez, F. Zhou, K. Dooling.
Statistical expertise: L.A. Prosser, R. Harpaz, A. Gebremariam, I.R. Ortega-Sanchez.
Obtaining of funding: L.A. Prosser, R. Harpaz, K. Dooling.
Administrative, technical, or logistic support: R. Harpaz, A.M. Rose.
Collection and assembly of data: L.A. Prosser, R. Harpaz, A.M. Rose, A. Gebremariam, K. Dooling.
The U.S. Advisory Committee on Immunization Practices recently developed recommendations for use of a new recombinant zoster vaccine (RZV).
To evaluate the cost-effectiveness of vaccination with RZV compared with zoster vaccine live (ZVL) and no vaccination, the cost-effectiveness of vaccination with RZV for persons who have previously received ZVL, and the cost-effectiveness of preferential vaccination with RZV over ZVL.
Simulation (state-transition) model using U.S. epidemiologic, clinical, and cost data.
Hypothetical cohort of immunocompetent U.S. adults aged 50 years or older.
Societal and health care sector.
Vaccination with RZV (recommended 2-dose regimen), vaccination with ZVL, and no vaccination.
The primary outcome measure was the incremental cost-effectiveness ratio (ICER).
For vaccination with RZV compared with no vaccination, ICERs ranged by age from $10 000 to $47 000 per quality-adjusted life-year (QALY), using a societal perspective and assuming 100% completion of the 2-dose RZV regimen. For persons aged 60 years or older, ICERs were less than $60 000 per QALY. Vaccination with ZVL was dominated by vaccination with RZV for all age groups 60 years or older.
Results were most sensitive to changes in vaccine effectiveness, duration of protection, herpes zoster incidence, and probability of postherpetic neuralgia. Vaccination with RZV after previous administration of ZVL yielded an ICER of less than $60 000 per QALY for persons aged 60 years or older. In probabilistic sensitivity analyses, RZV remained the preferred strategy in at least 95% of simulations, including those with 50% completion of the second dose.
Few data were available on risk for serious adverse events, adherence to the recommended 2-dose regimen, and probability of recurrent zoster.
Vaccination with RZV yields cost-effectiveness ratios lower than those for many recommended adult vaccines, including ZVL. Results are robust over a wide range of plausible values.
Centers for Disease Control and Prevention.
Prosser LA, Harpaz R, Rose AM, Gebremariam A, Guo A, Ortega-Sanchez IR, et al. A Cost-Effectiveness Analysis of Vaccination for Prevention of Herpes Zoster and Related Complications: Input for National Recommendations. Ann Intern Med. ;170:380–388. doi: 10.7326/M18-2347
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Published: Ann Intern Med. 2019;170(6):380-388.
Published at www.annals.org on 19 February 2019
High Value Care, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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