Cost-Effectiveness of Recombinant Zoster Vaccine for Adults Aged ≥50 Years in China

Abstract

Adjuvanted recombinant zoster vaccine (RZV) was the first vaccine made available for herpes zoster (HZ) in China. We aimed to evaluate its economic and health impacts in Chinese adults aged ≥50 years. A lifetime Markov model was developed to compare cost-effectiveness of RZV and no vaccination from a societal perspective. Model inputs were derived from published literature and analyzed in 2022. Outcomes included total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), number of HZ and HZ-related cases. Sensitivity analyses were performed to examine robustness of the model results. Compared with no vaccination, RZV was more costly by USD 2.78 billion with an additional 65,008 QALYs gained, and could avoid 1,893,530 HZ cases, 295,761 postherpetic neuralgia cases, 51,734 other complications, and 229 HZ-related deaths. ICERs of RZV varied in a range of USD 34,465.5-51,002.7/QALY. RZV for the entire cohort would be cost-effective when discount rate was <2.4%, a waning rate of two-dose RZV efficacy decreased to <0.8%, utility of PHN was <0.496, duration of PHN was >12.86 months, or cost of RZV per dose decreased to <USD 229.6. In probabilistic sensitivity analysis, the probability of RZV being cost-effective was 43.95%, 59.32%, 45.27%, and 39.50% for people aged 50-59, 60-69, 70-79, and ≥80 years, respectively, with 3-fold GDP per capita (37,654.5/QALY) as the willingness-to-pay threshold. RZV was most likely to be cost-effective in people aged 60-69 years. A slight decrease in vaccine cost would result in RZV being cost-effective in all people aged ≥50 years.