Health economic evaluation of a vaccine for the prevention of herpes zoster (shingles) and post-herpetic neuralgia in adults in Belgium

Abstract

Objective:

To determine the cost-effectiveness of vaccination against herpes zoster (HZ) and post-herpetic neuralgia (PHN) in individuals aged 60 years and older in Belgium.

Methods:

A Markov model was developed to compare the cost-effectiveness of vaccination with that of a policy of no vaccination. The model estimated the lifetime incidence and consequences of HZ and PHN using inputs derived from Belgian data, literature sources, and expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life-year (QALY) gained.

Results:

Vaccination in individuals aged 60 years and older resulted in ICERs of €6,799 (third party payer perspective), €7,168 (healthcare perspective), and €7,137 (societal perspective). The number needed to vaccinate to prevent one case was 12 for HZ, and 35 or 36 for PHN depending on the definition used. Univariate sensitivity analyses produced ICERs of €4,959–19,052/QALY; duration of vaccine efficacy had the greatest impact on cost-effectiveness. Probabilistic sensitivity analysis showed at least a 94% probability of ICERs remaining below the unofficial €30,000 threshold.

Discussion:

Key strengths of the model are the combination of efficacy data from a pivotal clinical trial with country-specific epidemiological data and complete sensitivity analysis performed. Main limitations are the use of non country-specific PHN proportion and non Belgian disease-specific utilities. Results are comparable with those recently published.

Conclusions:

HZ vaccination in individuals aged 60 years and older would represent a cost-effective strategy in Belgium.

Key words:

• Belgium
• Cost-effectiveness
• Herpes zoster
• Post-herpetic neuralgia
• Vaccination

Transparency

Declaration of funding

This study was funded by Sanofi Pasteur MSD, France.

Declaration of financial/other relationships

L.A. has disclosed that he received grants from Sanofi Pasteur to conduct this study. X.B. and C.G. have disclosed that they are employees of Sanofi Pasteur. M.P. has disclosed that he is an employee of i3 Innovus, a company who was received funding to conduct this study.

Acknowledgements

The authors gratefully acknowledge the contribution of M. Lamotte and K. Caekelbergh from IMS Health, Belgium, and Communigen Limited, Oxford, UK for their assistance in preparing the manuscript.

Notes

*Zostavax is a registered trademark of Sanofi Pasteur MSD, Lyon, France.

†Calculated using the exchange rate in force on 15 November 2009 (£1 = €1.11974).