This article is more than 5 years old. Information may no longer be current.
Shingles vaccine shows poor value in patients aged 50-59 years
Click Here to Manage Email Alerts
Recent study data confirmed that the cost-effectiveness of the herpes zoster vaccine was low in patients aged 50 to 59 years.
Last year, the Advisory Committee on Immunization Practices updated its recommendations to exclude the herpes zoster (HZ) vaccine in patients aged 50 to 59 years, even though HZ incidence increases after age 50. To validate the new recommendation, Phuc Le, PhD, MPH, and Michael B. Rothberg, MD, MPH, from Cleveland Clinic, sought to determine whether the benefit of the HZ vaccine in this age group outweighed the cost of the vaccine based on generally accepted standards.
The researchers updated the decision-analytic Markov model to reflect vaccine-related and epidemiologic data from the Shingles Prevention Study, the Short-Term Persistence Substudy, the Long-Term Persistence Substudy, ZEST and other observational studies. The probability of mortality due to HZ was estimated from the CDC WONDER database. The cost of the vaccine was based on the CDC website and Medicare estimates. The cost effect of serious vaccine reactions was equivalent to a 3-day hospitalization. It was assumed that the vaccine was ineffective in patients after age 65 since the vaccine’s efficacy decreases with age, according to the researchers.
In a base-care analysis, the model predicated that 25 HZ diagnoses and one postherpetic neuralgia case would be prevented for every 1,000 patients who received the vaccine at age 50 years. The researchers estimated that it would cost an additional $137,000 to save 0.4 quality-adjusted life-years (QALYs). Assuming the entire U.S. population aged 50 years was vaccinated in 2013, the incremental costs of the HZ vaccine vs. no vaccine was estimated to be $613 million and the cost-effectiveness ratio (incremental cost divided by the incremental increase in effectiveness) would be $323,456 per QALY. This represents an amount “more than three times that generally considered reasonable,” the researchers wrote.
In sensitivity analysis used to determine the cost-effectiveness of the HZ vaccine in patients aged 50 to 59 years, the model estimated that patients aged 59 years had the highest effectiveness and the lowest cost, with a cost-effectiveness ratio of $113,121 per QALY compared with no vaccination.
“However, the vaccine was still expensive even if a patient waited until age 59 to receive it,” the researchers wrote. “Extrapolating the effect of age at vaccination, we believe that waiting until age 60 years, as is currently recommended, would be less expensive and more effective than vaccination at age 59 years.
“At current prices, affluent patients might still choose to be vaccinated before age 60 years, but congruent with the recommendation of the [ACIP], our cost-effectiveness results do not support universal vaccination for this age group.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts