PIN51 Health Economic Evaluation of the Vaccination Against Herpes Zoster and Postherpetic Neuralgia in Germany

Abstract

After infection, varicella-zoster-virus can reactivate as herpes zoster (HZ), a painful skin rash most commonly among the elderly. A HZ-complication is long-lasting pain after rash disappearance: postherpetic neuralgia (PHN). A vaccine has been licensed in Europe to prevent HZ/PHN in individuals aged ≥50 years. To support decision-making concerning a possible vaccination-recommendation in Germany we performed a health economic evaluation. We developed a 5-state Markov-model with age-specific transition probabilities. We compared a vaccination-strategy to a scenario without vaccination targeting different population-cohorts aged 50+ in Germany (50-54, 55-59, etc.) to identify the most cost-effective strategy. Besides the payer-perspective (PP), the societal-perspective (SP) - covering in addition to direct also indirect costs - was considered. Country-specific demographic, epidemiological, and cost-of-illness input-data were utilized. We assumed a vaccine price of 100 Euro/dose, lifelong duration of protection, and 20% vaccination-coverage. All monetary amounts were in Euro 2010. The cycle-length was a quarter, and the model ended when individuals died. The discount-rate was 3% for both, outcomes and costs. Outcomes were number of HZ- and PHN-cases avoided. Results were presented as incremental cost-effectiveness ratios (ICERs) and number-needed-to-vaccinate (NNV). Univariate deterministic sensitivity-analyses (DSA) were performed. When targeting a cohort aged 50-54 years, preventing one HZ-case costs approximately 400€ from PP and approximately 280€ from SP. In this age-cohort the NNV was 6. DSA showed that results were most sensitive to target-age at vaccination, vaccine price, and discount rate. When increasing the target-age to 85+ year-olds, ICERs were 3,646€ (PP) and 3,634€ (SP) per adverted HZ-case, respectively, indicating a lower cost-effectiveness of vaccination in this age-cohort; NNV increased to 37. When considering prevention of PHN-cases ICERs became less favourable. Vaccination appears as valuable prevention-option especially when targeting the 50-54-years age-cohort. However, target-age at vaccination, price, and duration of protection will be key-factors in decision-making.