Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

• We reviewed 15 cost-effectiveness studies of vaccination against herpes zoster (HZ) in North America and Europe.
• Differences in results are likely due to varying assumptions about duration of vaccine protection and quality-adjusted life years (QALY) loss due to HZ.
• Most studies in this review show that vaccination against HZ is likely to be cost-effective.

ObjectiveThe objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN).MethodsWe searched MEDLINE and EMBASE databases for eligible studies published prior to November 2013. We extracted information regarding model structure, model input parameters, and study results. We compared the results across studies by projecting the health and economic impacts of vaccinating one million adults over their lifetimes.ResultsWe identified 15 cost-effectiveness studies performed in North America and Europe. Results ranged from approximately US$10,000 to more than US$100,000 per quality-adjusted life years (QALY) gained. Most studies in Europe concluded that zoster vaccination is likely to be cost-effective. Differences in results among studies are largely due to differing assumptions regarding duration of vaccine protection and a loss in quality of life associated with HZ and to a larger extent, PHN. Moreover, vaccine efficacy against PHN, age at vaccination, and vaccine cost strongly influenced the results in sensitivity analyses.ConclusionMost studies included in this review shows that vaccination against HZ is likely to be cost-effective. Future research addressing key model parameters and cost-effectiveness studies in other parts of the world are needed.