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

Figures & data

Figure 1. Study selection process.

Table 1. Characteristics of included studies (n = 37).

Author	Country	WHO region	Time horizon	Model	Currency year	Threshold	Perspective	Vaccine comparison	Vaccination age
Hornberger 2006^29	USA	AMR	Lifetime	Decision theoretical model with health states	2006	$100,000	Societal	ZVL vs. NoV	Base case 69 60, 65, 70, 75, 80
Pellissier 2007^30	USA	AMR	Lifetime	Decision analytic model with pain states	2006	$50,000	Societal TPP	ZVL vs. NoV	60+
Rothberg 2007^31	USA	AMR	10 years	Markov	2005	$100,000	Societal	ZVL vs. NoV	60+
Brisson 2008^32	Canada	AMR	Lifetime	Markov	2005	CA$40,000	TPP (MoH)	ZVL vs. NoV	Base case 65 50, 60, 70, 80
Najafzadeh 2009^33	Canada	AMR	Lifetime	Discrete-event simulation	2008	CA$50,000	TPP (HCP)	ZVL vs. NoV	60+
van Hoek 2009^34	UK	EUR	Lifetime	Markov	2006	£30,000	HCP	ZVL vs. NoV	Base case 65 60, 70, 75
Annemans 2010^35	Belgium	EUR	Lifetime	Markov	2007	€30,000	Societal HCP TPP	ZVL vs. NoV	60+
Moore 2010^36	UK	EUR	Lifetime	Markov	2006	£30,000	TPP (NHS) Societal	ZVL vs. NoV	50+
van Lier 2010^37	Netherlands	EUR	7.5 years	Markov	2008	€20,000	Societal	ZVL vs. NoV	Base case 70 60, 65, 75, 80
Szucs 2011^38	Switzerland	EUR	Lifetime	Markov	2011	CHf30,000	Societal TPP	ZVL vs. NoV	Base case 70–79
Bresse 2013^39	France	EUR	10 years	Markov	2010	€28,000	HCP TPP	ZVL vs. NoV	65+, 70–79
de Boer 2013^40	Netherlands	EUR	Lifetime	Markov	2010	€50,000	Societal	ZVL vs. NoV	Base case 60 65, 70, 75
Ultsch 2013^41	Germany	EUR	Lifetime	Markov	2010	€30,000	Societal	ZVL vs. NoV	60
Preaud 2015^42	Germany	EUR	Lifetime	Markov	2013	€45,000	Societal HCP (SHI)	ZVL vs. NoV	50+, 60+
Le 2015^43	USA	AMR	Lifetime	Markov	2014	$100,000	Societal	ZVL vs. NoV	50
Belchoir 2016^44	France	EUR	Lifetime	Markov	2012	€50,000	Societal	ZVL vs. NoV	60–64, 65–69, 70–74, 75–79
Bilde 2016^45	Denmark	EUR	Lifetime	Markov	2011	Kr270,000	Societal	ZVL vs. NoV	65+
Coretti 2016^46	Italy	EUR	Lifetime	Markov	2014	€30,000	Societal TPP (I-NHS)	ZVL vs. NoV	60–79
Lopez-Belmonte 2016^47	Spain	EUR	Lifetime	Markov	2013	€30,000	Societal TPP	ZVL vs. NoV	50+
Blank 2017^48	Switzerland	EUR	Lifetime	Markov	2014	CHf40,000	TPP	ZVL vs. NoV	65–79
Hoshi 2017^49	Japan	WPR	Lifetime	Markov	2016	¥5,000,000	Societal	ZVL vs. NoV	Base case 65–84 70–84, 75–84, 80–84
Pan 2017^50	Singapore	WPR	Lifetime	Decision analytic Markov	2013	SG$65,000	Societal	ZVL vs. NoV	50+
Le 2017^51	USA	AMR	Lifetime	Markov	2014	$100,000	Societal	ZVL vs. NoV ZVL + booster vs. NoV ZVL + 2 boosters vs. NoV	60, 70
Le 2018^52	USA	AMR	Lifetime	Markov	2016	$50,000	Societal	RZV vs. ZVL RZV vs. NoV	60, 70, 80
Carpenter 2019^53	USA	AMR	Lifetime	Markov	2018	$100,000	Societal	ZVL vs. NoV RZV vs. NoV	50, 60, 70
Curran 2018^54	USA	AMR	Lifetime	Markov	2016	$100,000	Societal	RZV vs. NoV RZV vs. ZVL	60+
Curran 2019^55	USA	AMR	Lifetime	Markov	2016	$100,000	Societal	RZV in previous ZVL vs. ZVL RZV vs. ZVL + booster	60+
de Boer 2018^56	Netherlands	EUR	15 years	Markov with decision tree	2017	€20,000	Societal	ZVL vs. NoV ZVL + booster vs. NoV RZV vs. NoV	50, 60, 70, 80
Drolet 2019^57	Canada	AMR	Lifetime	Decision analytic static cohort	2018	CA$45,000	HCP	RZV vs. NoV ZVL vs. NoV	65
Hoshi 2019^58	Japan	WPR	Lifetime	Markov with decision tree	2017	¥5,000,000	TPP	RZV vs. NoV ZVL vs. NoV	65–84, 70–84, 75–84, 80–84
McGirr 2019^59	Canada	AMR	Lifetime	Markov	2016	CA$50,000	HCP	RZV vs. NoV RZV vs. ZVL	60+
Melegaro 2018^60	Italy	EUR	Lifetime	Stochastic individual based model	2015	€40,000	Societal	ZVL vs. NoV ZVL + booster vs. NoV	65
Prosser 2019^61	USA	AMR	Lifetime	Simulation (state-transition)	2016	$100,000	Societal	RZV vs. NoV ZVL vs. NoV	50–59, 60–69, 70–79, 80–89, 90–99
Shiragami 2019^62	Japan	WPR	Lifetime	Markov	2017	¥5,000,000	TPP Societal	RZV vs. NoV	65+
van Oorschot 2019^63	Germany	EUR	Lifetime	Markov	2017	€50,000	Societal	RZV vs. NoV	Base case 60+, 70+ 60, 65, 70
You 2018^64	Hong Kong, China	WPR	Lifetime	Markov	2016	$130,590	Societal	RZV vs. NoV	50, 60, 70
You 2019^65	Hong Kong, China	WPR	Lifetime	Markov	2017	$46,153	Societal	RZV vs. NoV	50, 60, 70, 80

Note. All studies conducted cost-utility analysis (CUA).

Figure 2. Pooling the INB of ZVL vs. NoV for societal perspective by age groups.

Table 2. Meta-analysis results for main groups.

Analysis groups and vaccination age (years)	n Studies	n Analyses	INB (2019 USD)	95% CI	I^2	p-Value	Egger’s test
							Coefficient	SE	p-Value
SP–ZVL vs. NoV
50+ to 70+		11	19.429	−7.194, 46.052	0.00	.925	0.43	0.540	.4257
50–59		3	0.610	0.369, 0.850	0.00	.387	−0.76	0.708	.2842
60–69		13	−17.945	−25.030, −10.861	99.90	<.001	0.73	0.431	.0884
70–79		12	9.673	5.204, 14.142	99.75	<.001	1.08	0.446	.0158
80–99		3	−16.864	−56.883, 23.154	99.89	<.001	0.73	1.088	.5010
Overall	21	42	−5.776	−8.706, −2.847	99.78	<.001	0.55	0.204	.0076
SP–RZV vs. NoV
50+ to 70+		4	24.056	−34.704, 82.816	0.00	.658	0.76	0.916	.4050
50–59		5	30.582	−8.821, 69.985	62.48	.031	0.93	0.678	.1714
60–69		6	75.607	17.981, 133.233	78.01	<.001	1.23	0.686	.0734
70–79		6	85.013	30.022, 140.005	85.67	<.001	2.48	0.645	.0001
80–99		5	24.863	−15.750, 65.476	71.78	.007	2.25	0.610	.0002
Overall	9	26	49.504	28.261, 70.747	79.21	<.001	1.52	0.292	<.001
SP–RZV vs. ZVL
50+ to 70+		1	228.408	−0.795, 457.611	–	–	–	–	–
50–59		1	105.706	−139.734, 351.147	–	–	–	–	–
60–69		1	222.315	−22.748, 467.378	–	–	–	–	–
70–79		1	388.518	25.515, 751.521	–	–	–	–	–
80–99		2	528.237	231.837, 824.637	0.00	1.00	–	–	–
Overall	2	6	266.671	143.377, 389.965	6.14	.257	3.50	1.622	.0352
TPP–ZVL vs. NoV
50+ to 70+		11	8.625	3.622, 13.629	0.00	.773	0.40	0.349	.2480
50–59		1	−24.548	−153.530, 104.435	–	–	–	–	–
60–69		4	12.465	−45.485, 70.415	0.00	.999	0.18	1.543	.9080
70–79		2	7.566	0.268, 14.863	0.00	.785	0.29	1.057	.7866
80–99		1	−36.684	−145.272, 71.905	–	–	–	–	–
Overall	14	19	8.210	4.099, 12.321	0.00	.913	0.19	0.264	.4754
TPP–RZV vs. NoV
50+ to 70+		3	54.703	−109.168, 218.575	0.00	.895	−0.73	1.592	.6487
60–69		1	220.869	47.804, 393.935	–	–	–	–	–
Overall	4	4	133.255	14.263, 252.248	0.00	.172	−1.50	1.359	.2708

SP: societal perspective; TPP: third-party payer perspective; ZVL: zoster vaccine live; RZV: recombinant subunit vaccine; NoV: no vaccine; SE: standard error.

Figure 3. Pooling the INB of RZV vs. NoV for societal perspective by age groups.

Figure 4. Pooling the INB of RZV vs. ZVL for societal perspective by age groups.

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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.