College of Public Health, Kent State University, Kent, OH, USA.
SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Pharmacoeconomics. 2019 Feb;37(2):169-200. doi: 10.1007/s40273-018-0735-1.
Herpes zoster (HZ) is one of the most common diseases among adults. Its reactivation is characterized by a severe and painful complication. In addition to the existing herpes zoster vaccine (ZVL), the FDA approved a new adjuvanted subunit zoster vaccine (RZV) in 2017 for use in adults aged 50 years and older. Several studies have assessed the cost-effectiveness of ZVL, many of which were conducted before the long-term vaccine efficacy data was available in 2014.
Our objectives were to (i) summarize and compare the cost-effectiveness analyses (CEAs) of ZVL conducted before and after 2014, (ii) summarize the CEAs of RZV, and (iii) critically assess the cost-effectiveness models and identify key parameters to consider for future CEAs of RZV.
We searched PubMed and two other databases from inception to March 2018 for original cost-effectiveness, cost-utility, or cost-benefit analyses of HZ vaccines. Three investigators independently reviewed and assessed full-text articles after screening the titles and abstracts to determine eligibility. For all included studies, we assessed study quality using the Drummond and Jefferson's checklist and extracted study characteristics, model structure, vaccine characteristics, incidence of HZ and complications, incremental cost-effectiveness ratio, and sensitivity analyses. We summarized data by type of vaccine, year of publication, and funding sources.
Twenty-seven studies met eligibility criteria. All studies were from high-income countries and were of moderate-to-high or high quality. Twenty studies repeatedly used four cost-effectiveness models. The assumption on long-term efficacy of ZVL was not based on clinical trial data in > 50% of studies. Fifteen out of 25 studies concluded that ZVL was cost-effective compared with no vaccine at a vaccine price ranging between US$93 and US$236 per dose (2018 US$), 40% of which were published after 2014. All industry-funded studies favored the use of ZVL. The single study assessing RZV found it to be more effective and less costly than ZVL, and cost-effective compared with no vaccination. More studies conducted after 2014 included various efficacy endpoints for ZVL, adverse reactions, and productivity loss compared with those conducted before 2014.
A majority of studies of ZVL found it to be cost-effective compared with no vaccine using the authors' chosen willingness-to-pay thresholds. RZV was dominant in the single study comparing the two vaccines, but the finding needs to be confirmed with further studies in different settings. Future studies should assume vaccine efficacy in line with clinical data, account for more efficacy endpoints for ZVL, and include other HZ long-term complications, vaccine adverse reactions, and productivity loss.
带状疱疹 (HZ) 是成年人中最常见的疾病之一。其复发的特点是严重且疼痛的并发症。除了现有的带状疱疹疫苗 (ZVL) 外，FDA 于 2017 年批准了一种新的佐剂亚单位带状疱疹疫苗 (RZV)，供 50 岁及以上的成年人使用。几项研究评估了 ZVL 的成本效益，其中许多研究是在 2014 年获得长期疫苗疗效数据之前进行的。
我们的目标是 (i) 总结和比较 2014 年前后进行的 ZVL 的成本效益分析 (CEA)，(ii) 总结 RZV 的 CEA，以及 (iii) 批判性评估成本效益模型，并确定未来 RZV 的 CEA 中需要考虑的关键参数。
我们从建库至 2018 年 3 月在 PubMed 和另外两个数据库中检索了 HZ 疫苗的原始成本效益、成本效用或成本效益分析的研究。三名调查员在筛选标题和摘要后，独立审查和评估了全文文章，以确定是否符合入选标准。对于所有纳入的研究，我们使用 Drummond 和 Jefferson 的清单评估了研究质量，并提取了研究特征、模型结构、疫苗特征、HZ 和并发症的发生率、增量成本效益比和敏感性分析。我们根据疫苗类型、出版年份和资金来源总结数据。
27 项研究符合入选标准。所有研究均来自高收入国家，质量为中等到高度或高度。20 项研究重复使用了四种成本效益模型。ZVL 长期疗效的假设在超过 50%的研究中并非基于临床试验数据。25 项研究中有 15 项得出结论，与不接种疫苗相比，ZVL 在疫苗价格为 93 至 236 美元（2018 年美元）之间时具有成本效益，其中 40%的研究是在 2014 年后发表的。所有行业资助的研究都支持使用 ZVL。唯一一项评估 RZV 的研究发现，与 ZVL 相比，它更有效且成本更低，并且与不接种疫苗相比具有成本效益。与 2014 年前相比，更多的研究在 2014 年后纳入了 ZVL 的各种疗效终点、不良反应和生产力损失。
大多数 ZVL 研究发现，与不接种疫苗相比，使用作者选择的意愿支付阈值具有成本效益。在比较两种疫苗的单一研究中，RZV 占主导地位，但这一发现需要在不同环境中进行更多研究来证实。未来的研究应根据临床数据假设疫苗疗效，考虑到 ZVL 的更多疗效终点，并纳入其他 HZ 长期并发症、疫苗不良反应和生产力损失。
