Incremental net monetary benefit of herpes zoster vaccination: a systematic review and meta-analysis of cost-effectiveness evidence

Abstract

Objectives

To perform a systematic review and meta-analysis to pool the incremental net benefit (INB) of each herpes zoster vaccine [i.e. Zoster Vaccine Live (ZVL) and Recombinant Zoster Vaccine (RZV)].

Methods

We initially identified individual studies by hand-searching reference lists of the relevant systematic review articles. An updated comprehensive search was performed in Medline, Scopus, and Embase until June 2020 for additional studies. Studies were eligible if they assessed the cost-effectiveness/utility of any pair among ZVL and RZV, and no vaccine and reported economic outcomes. Details of the study characteristics, economic model inputs, costs, and outcomes were extracted. INB was calculated with monetary units adjusting for purchasing power parity for 2019 US dollars and pooled by meta-analysis.

Results

A total of 37 studies were pooled for meta-analysis stratified by perspectives [i.e. societal (SP) and third-party payer (TPP)] and vaccine types. In SP, ZVL was cost-effective compared to no vaccine when vaccinated at ages of 50–59 and 70–79 years with INBs (95% CI) of $0.61 (0.37, 0.85) and $9.67 (5.20, 14.14), respectively. RZV was cost-effective for those aged 60–69 and 70–79 years with INBs of $75.61 (17.98, 133.23) and $85.01 (30.02, 140.01), respectively. In TPP, ZVL was cost-effective compared to no vaccine when vaccinated at age 70–79 years with INB of $7.57 (0.27, 14.86) and RZV was cost-effective at 60–69 years with INB $220.87 (47.80, 393.93). The cost-effectiveness of RZV was robust across a series of sensitivity analyses, but ZVL differs on different vaccination ages.

Conclusions

RZV may be cost-effective for vaccination in ages of 60–79 years for both SP and TPP perspectives, while ZVL might be cost-effective in some age groups, but results are not robust.

Keywords:

• Herpeszoster
• vaccine
• systematic review
• meta-analysis
• economic evaluation

JEL CLASSIFICATION CODES:

• A10
• A1
• A
• C00
• C

Transparency

Declaration of funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Declaration of financial/other relationships

The authors declare that they have no known conflicts of interest that are directly relevant to the content of this article.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S.U. and M.G.R. reviewed literatures, extracted data for the study, synthesis, and quality assessment with input from N.C., A.T., and T.A. S.U. did the meta-analysis. S.U., M.G.R., and S.V. wrote the first drafts of the manuscript and all authors made substantial contribution. All authors contributed to the study design, interpretation of findings, and critical revision of the manuscript.

Acknowledgements

None reported.

Data availability statement

All data are available from the corresponding author upon request.

Code availability

The data analysis file is available from the corresponding author upon request.

Consent for publication

All authors approved the final version of the manuscript for submission.