Ann Arbor, MI—How cost-effective is the use of Shingrix (recombinant zoster vaccine [RZV]), which protects against herpes zoster (HZ), among immunocompromised adults aged 19 to 49 years?
That was asked in a study conducted to contribute to deliberations of the Advisory Committee on Immunization Practices. The researchers from the University of Michigan worked with the CDC on the investigation, and the results were published in the journal Value Health.
The authors noted that hematopoietic cell transplant (HCT) recipients experience a high incidence of HZ, and the efficacy of RZV in preventing HZ has been studied in clinical trials. The researchers used a cost-effectiveness model to calculate incremental cost-effectiveness ratios that compared vaccination with RZV with a no-vaccination strategy among adults aged 19 to 49 years. For the study, costs and outcomes were calculated up to age 50 years using the healthcare sector perspective and summarized as cost per quality-adjusted life-year (QALY) gained.
“The base case represents HCT recipients, with scenario analyses representing persons with other immunocompromising conditions, including hematologic malignancies, human immunodeficiency virus, and autoimmune and inflammatory conditions,” the authors pointed out.
“Base-case results indicated vaccination with RZV would avert approximately 35% of HZ episodes and complications, while saving approximately 11% of net costs,” according to the authors. “Compared with no vaccination, vaccination of HCT recipients with RZV generated cost-savings (i.e., lower costs and improved health) in the base case and 81% of simulations in the probabilistic analysis.”
Using a scenario analysis, researchers calculated that vaccination costs were $9,500/QALY among patients with hematologic malignancies, $79,000/QALY among persons living with human immunodeficiency virus, and $208,000/QALY among persons with selected autoimmune and inflammatory conditions.
Generally favorable economic estimates supported recommendations for vaccination of immunocompromised adults with RZV to prevent episodes of HZ and related complications.
Immunocompromised patients experience a higher incidence of HZ and related complications, according to a report in the CDC’s Morbidity & Mortality Weekly report. It noted that, in the summer of 2021, the FDA expanded the indication for use of RZV to include immunodeficient or immunosuppressed adults.
That October, the Advisory Committee on Immunization Practices recommended two RZV doses for the prevention of HZ and related complications in immunodeficient or immunosuppressed adults aged 19 years and older.
“RZV is the first herpes zoster vaccine approved for use in immunocompromised persons. With moderate to high vaccine efficacy and an acceptable safety profile, RZV has the potential to prevent considerable herpes zoster incidence and related complications,” wrote authors from the CDC, Stanford University School of Medicine, and Harvard Medical School.
Background information in the article noted that the risk for HZ and related complications is “generally higher in immunocompromised compared with immunocompetent adults, although there is heterogeneity within and across immunocompromised groups. The risk for herpes zoster among younger adults with certain immunocompromising conditions can be comparable to or higher than that in the general adult population aged >50 years.”
The authors emphasized that because immunosuppression and immunodeficiency were contraindications for the previously available vaccine, zoster vaccine live, and RZV was originally recommended for immunocompetent adults aged 50 years and older, “there has been an unmet need for vaccination against herpes zoster in immunocompromised adults.”
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Published November 7, 2022