At a projected price of $280 per 2-dose course, the adjuvanted herpes zoster subunit (HZ/su) vaccine is more effective and less expensive than the live attenuated herpes zoster vaccine at all ages, according to a study published in JAMA Internal Medicine.

Phuc Le, PhD, MPH, and Michael B. Rothberg, MD, MPH, from the Center for Value-Based Care Research, Medicine Institute at the Cleveland Clinic, compared the cost-effectiveness of the following 3 strategies: (1) no vaccination, (2) vaccination with the live attenuated herpes zoster vaccine (ZVL), and (3) vaccination with HZ/su. The ZVL strategy included 1 dose, and the HZ/su strategy included 2 doses administered 2 months apart. Participants were immunocompetent adults aged 60 years or older. The study was conducted from July 1, 2017, to July 31, 2017.

Cost of ZVL was based on the private sector price of the Centers for Disease Control and Prevention. Because HZ/su is not yet licensed, the authors estimated a base-case price of $280 for a 2-dose regimen and varied it in sensitivity analysis. Administration cost was set at Medicare’s national reimbursement rate.

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Based on randomized clinical trial data, at a price of $280 per series ($140 per dose), HZ/su was more effective and less expensive than ZVL at all ages. The incremental cost-effectiveness ratios compared with no vaccination ranged from $20,038 to $30,084 per quality-adjusted life-year (QALY), depending on vaccination age. The finding was insensitive to variations in most model inputs other than the vaccine price and certain combinations of low adherence rate with a second dose and low efficacy of a single dose of HZ/su.

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At the current ZVL price ($213 per dose), HZ/su had lower overall costs than ZVL up to a price of $350 per 2-dose series. In probabilistic sensitivity analysis, HZ/su had a 73% probability of being cost-effective for 60-year-olds at $50 000 per QALY.

“In this modeling study based on RCT data, we found that the new HZ/su was highly cost-effective compared with no vaccination for people 60 years or older,” the authors concluded. “At a proposed price of $280 per series, HZ/su was both more effective and less expensive than the current ZVL at all ages.”


Le P, Rothberg MB. Cost-effectiveness of the adjuvanted herpes zoster subunit vaccine in older adults. JAMA Intern Med. 2018 Jan 2. doi: 10.1001/jamainternmed.2017.7431