Economic evaluation of a vaccine for the prevention of herpes zoster and post-herpetic neuralgia in older adults in Switzerland

Abstract

Background: A life-attenuated vaccine aimed at preventing herpes zoster (HZ) and its main complication, post-herpetic neuralgia (PHN), will soon be available in Europe. The study’s objective was to assess the clinical and economic impact of a vaccination program for adults aged 70-79 years in Switzerland. Results: A vaccination strategy compared to a no-vaccination resulted in lifetime incremental cost-effectiveness ratios (ICERs) of 25,538 CHF (23,646 USD) per QALY gained, 6,625 CHF (6,134 USD) per HZ case avoided, and 15,487 CHF (14,340 USD) per PHN3 case avoided under the third-party payer perspective. Sensitivity analyses showed that the model was most sensitive to the discount rates, HZ epidemiological data and vaccine price used. Methods: A Markov model, simulating the natural history of HZ and PHN and the lifetime effects of vaccination, previously developed for the UK was adapted to the Swiss context. The model includes several health states including good health, HZ, PHN, and death. HZ and PHN states reflected pain severity. Conclusion: The model predicts clinical and economic benefits of vaccination in the form of fewer HZ and PHN cases and reductions in healthcare resource use. ICERs were within the commonly accepted thresholds in Switzerland, indicating that a HZ vaccination program would be considered a cost-effective strategy in the Swiss setting.

Conflict of Interest

A. Fendl and X. Bresse are employed by SPMSD who funded the study. All other authors declare that they have no competing interests.

Financial Disclosure

This study was carried out independently by i3 Innovus and was fully funded by SPMSD.

Figures and Tables

Figure 1 Model Health States.

Figure 2 Univariate sensitivity analyses: tornado diagram.

Appendix Figure 1 The cost-effectiveness plane.

Table 1 Input data: epidemiology, utilities and vaccine characteristics

Table 2 Input data: management costs, productivity costs and vaccination costs