Advertisement

Cost-Effectiveness Analysis of Vaccination With Recombinant Zoster Vaccine Among Hematopoietic Cell Transplant Recipients and Persons With Other Immunocompromising Conditions Aged 19 to 49 Years

Published:October 13, 2022DOI:https://doi.org/10.1016/j.jval.2022.08.003

      Highlights

      • In a cost-effectiveness analysis, the use of recombinant zoster vaccine (RZV) among adults aged 19 to 49 years who received a hematopoietic cell transplant was found to be cost-saving in the base-case scenario and in most sensitivity analyses. Scenario analyses investigating persons with other selected immunocompromising conditions resulted in a wide range of economic values.
      • Generally favorable economic estimates further support that vaccination of immunocompromised adults with RZV should be a clinical priority to prevent episodes of herpes zoster and related complications.
      • In October 2021, RZV (Shingrix) was recommended for use among immunocompromised adults aged ≥ 19 years.

      Abstract

      Objectives

      This study aimed to estimate the cost-effectiveness of the use of recombinant zoster vaccine (RZV) (Shingrix), which protects against herpes zoster (HZ), among immunocompromised adults aged 19 to 49 years, as a contribution to deliberations of the Advisory Committee on Immunization Practices.

      Methods

      Hematopoietic cell transplant (HCT) recipients experience a high incidence of HZ, and the efficacy of RZV in preventing HZ has been studied in clinical trials. The cost-effectiveness model calculated incremental cost-effectiveness ratios that compared vaccination with RZV with a no vaccination strategy among adults aged 19 to 49 years. Costs and outcomes were calculated until age 50 years using the healthcare sector perspective and summarized as cost per quality-adjusted life-year (QALY) gained. The base case represents HCT recipients, with scenario analyses representing persons with other immunocompromising conditions, including hematologic malignancies, human immunodeficiency virus, and autoimmune and inflammatory conditions. Uncertainty was investigated using univariate, multivariate, and probabilistic sensitivity analyses.

      Results

      Base-case results indicated vaccination with RZV would avert approximately 35% of HZ episodes and complications, while saving approximately 11% of net costs. Compared with no vaccination, vaccination of HCT recipients with RZV generated cost-savings (ie, lower costs and improved health) in the base case and in 81% of simulations in the probabilistic analysis. In scenario analyses, vaccination cost US dollar ($) 9500/QALY among patients with hematologic malignancies, $79 000/QALY among persons living with human immunodeficiency virus, and $208 000/QALY among persons with selected autoimmune and inflammatory conditions.

      Conclusions

      Generally favorable economic estimates supported recommendations for vaccination of immunocompromised adults with RZV to prevent episodes of HZ and related complications.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Value in Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Insinga R.P.
        • Itzler R.F.
        • Pellissier J.M.
        • Saddier P.
        • Nikas A.A.
        The incidence of herpes zoster in a United States administrative database.
        J Gen Intern Med. 2005; 20: 748-753
        • Dooling K.L.
        • Guo A.
        • Patel M.
        • et al.
        Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 103
        • Leidner A.J.
        Overview of two economic models that assess the cost-effectiveness of herpes zoster vaccinations. Centers for Disease Control and Prevention.
        https://stacks.cdc.gov/view/cdc/58912
        Date: 2017
        Date accessed: October 3, 2022
        • Prosser L.A.
        • Harpaz R.
        • Rose A.M.
        • et al.
        A cost-effectiveness analysis of vaccination for prevention of herpes zoster and related complications: input for national recommendations.
        Ann Intern Med. 2019; 170: 380-388
        • Curran D.
        • Patterson B.
        • Varghese L.
        • et al.
        Cost-effectiveness of an adjuvanted recombinant zoster vaccine in older adults in the United States.
        Vaccine. 2018; 36: 5037-5045
        • McKay S.L.
        • Guo A.
        • Pergam S.A.
        • Dooling K.
        Herpes zoster risk in immunocompromised adults in the United States: a systematic review.
        Clin Infect Dis. 2020; 71: e125-e134
        • Yun H.
        • Yang S.
        • Chen L.
        • et al.
        Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccination.
        Arthritis Rheumatol. 2016; 68: 2328-2337
        • Harpaz R.
        • Leung J.W.
        The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among older adults.
        Clin Infect Dis. 2019; 69: 341-344
      1. Supplement approval. Food and Drug Administration.
        https://www.fda.gov/media/151063/download
        Date: 2021
        Date accessed: October 3, 2022
        • Chen S.Y.
        • Suaya J.A.
        • Li Q.
        • et al.
        Incidence of herpes zoster in patients with altered immune function.
        Infection. 2014; 42: 325-334
        • Zhang D.
        • Weiss T.
        • Feng Y.
        • Finelli L.
        Duration of antiviral prophylaxis and risk of herpes zoster among patients receiving autologous hematopoietic stem cell transplants: a retrospective, observational study.
        Adv Ther. 2017; 34: 1610-1621
        • Seo H.M.
        • Kim Y.S.
        • Bang C.H.
        • et al.
        Antiviral prophylaxis for preventing herpes zoster in hematopoietic stem cell transplant recipients: a systematic review and meta-analysis.
        Antiviral Res. 2017; 140: 106-115
        • Weinmann S.
        • Chun C.
        • Schmid D.S.
        • et al.
        Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009.
        J Infect Dis. 2013; 208: 1859-1868
        • Harpaz R.
        • Leung J.W.
        The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among children.
        Clin Infect Dis. 2019; 69: 345-347
      2. ACIP evidence to recommendations framework for use of recombinant zoster vaccine in immunocompromised adults aged ≥19 years. Centers for Disease Control and Prevention.
        • Bastidas A.
        • de la Serna J.
        • El Idrissi M.
        • et al.
        Effect of recombinant zoster vaccine on incidence of herpes zoster after autologous stem cell transplantation: a randomized clinical trial.
        JAMA. 2019; 322: 123-133
        • Ortega-Sanchez I.
        Economics of vaccinating immunocompromised 19-49-years-old adults against herpes zoster in the US: a summary report of CDC & GSK models.
        https://stacks.cdc.gov/view/cdc/110714
        Date: 2021
        Date accessed: October 3, 2022
      3. Evidence to recommendations frameworks. Centers for Disease Control & Prevention.
        • Anderson T.C.
        WG interpretation of the EtR regarding use of RZV in immunocompromised adults, considerations for use and proposed policy changes. Centers for Disease Control & Prevention.
        https://stacks.cdc.gov/view/cdc/110910
        Date: 2021
        Date accessed: October 3, 2022
        • Anderson T.C.
        • Masters N.B.
        • Guo A.
        • et al.
        Use of recombinant zoster vaccine in immunocompromised adults aged ≥19 years: recommendations of the Advisory Committee on Immunization Practices - United States, 2022.
        MMWR Morb Mortal Wkly Rep. 2022; 71: 80-84
      4. Transplant activity report covering 2013-2017. Center for International Blood and Marrow Transplant Research.
        • Izurieta H.S.
        • Wu X.
        • Forshee R.
        • et al.
        Recombinant zoster Vaccine (Shingrix) real-world effectiveness in the first two years post-licensure.
        Clin Infect Dis. 2021; 73: 941-948
      5. Watson Health, IBM(R) MarketScan(R) Research Databases for Health Services Researchers, IBM Corporation. 2019. Accessed 30 April 2021.

        • Yanni E.A.
        • Ferreira G.
        • Guennec M.
        • et al.
        Burden of herpes zoster in 16 selected immunocompromised populations in England: a cohort study in the Clinical Practice Research Datalink 2000-2012.
        BMJ Open. 2018; 8e020528
        • Arias E.
        • Xu J.
        United States life tables, 2007. Natl Vital Stat Rep. 2017; 68: 1-65
        • Ashton L.J.
        • Le Marsney R.E.
        • Dodds A.J.
        • et al.
        A population-based cohort study of late mortality in adult autologous hematopoietic stem cell transplant recipients in Australia.
        Biol Blood Marrow Transplant. 2014; 20: 937-945
        • D’Souza A.
        • Fretham C.
        • Lee S.J.
        • et al.
        Current use and trends in hematopoietic cell transplantation in the United States.
        Biol Blood Marrow Transplant. 2020; 26: e177-e182
        • Hanmer J.
        • Lawrence W.F.
        • Anderson J.P.
        • Kaplan R.M.
        • Fryback D.G.
        Report of nationally representative values for the noninstitutionalized US adult population for 7 health-related quality-of-life scores.
        Med Decis Making. 2006; 26: 391-400
        • Sisk J.E.
        • Whang W.
        • Butler J.C.
        • Sneller V.P.
        • Whitney C.G.
        Cost-effectiveness of vaccination against invasive pneumococcal disease among people 50 through 64 years of age: role of comorbid conditions and race.
        Ann Intern Med. 2003; 138: 960-968
        • Harvey M.
        • Prosser L.A.
        • Rose A.M.
        • Ortega-Sanchez I.R.
        • Harpaz R.
        Aggregate health and economic burden of herpes zoster in the United States: illustrative example of a pain condition.
        Pain. 2020; 161: 361-368
        • Lieu T.A.
        • Ortega-Sanchez I.
        • Ray G.T.
        • et al.
        Community and patient values for preventing herpes zoster.
        Pharmacoeconomics. 2008; 26: 235-249
        • Curran D.
        • Matthews S.
        • Rowley S.D.
        • et al.
        Recombinant zoster vaccine significantly reduces the impact on quality of life caused by herpes zoster in adult autologous hematopoietic stem cell transplant recipients: a randomized placebo-controlled trial (ZOE-HSCT).
        Biol Blood Marrow Transplant. 2019; 25: 2474-2481
        • Lee G.M.
        • Salomon J.A.
        • LeBaron C.W.
        • Lieu T.A.
        Health-state valuations for pertussis: methods for valuing short-term health states.
        Health Qual Life Outcomes. 2005; 3: 1-14
        • Le P.
        • Rothberg M.B.
        Cost-effectiveness of the adjuvanted herpes zoster subunit vaccine in older adults.
        JAMA Intern Med. 2018; 178: 248-258
        • Prosser L.A.
        • Payne K.
        • Rusinak D.
        • Shi P.
        • Uyeki T.
        • Messonnier M.
        Valuing health across the lifespan: health state preferences for seasonal influenza illnesses in patients of different ages.
        Value Health. 2011; 14: 135-143
        • Johnson B.H.
        • Palmer L.
        • Gatwood J.
        • Lenhart G.
        • Kawai K.
        • Acosta C.J.
        Healthcare resource utilization and costs associated with herpes zoster in the US.
        J Med Econ. 2016; 19: 928-935
        • Yawn B.P.
        • Itzler R.F.
        • Wollan P.C.
        • Pellissier J.M.
        • Sy L.S.
        • Saddier P.
        Health care utilization and cost burden of herpes zoster in a community population.
        Mayo Clin Proc. 2009; 84: 787-794
        • Leidner A.J.
        • Tang Z.
        • Guo A.
        • Anderson T.C.
        • Tsai Y.
        Insurance reimbursements for recombinant zoster vaccine in the private sector.
        Vaccine. 2022; 39: 5091-5094
        • Tsai Y.
        • Zhou F.
        • Lindley M.C.
        Insurance reimbursements for routinely recommended adult vaccines in the private sector.
        Am J Prev Med. 2019; 57: 180-190
        • Poudel D.R.
        • Acharya P.
        • Ghimire S.
        • Dhital R.
        • Bharati R.
        Burden of hospitalizations related to adverse drug events in the USA: a retrospective analysis from large inpatient database.
        Pharmacoepidemiol Drug Saf. 2017; 26: 635-641
        • Dagnew A.F.
        • Ilhan O.
        • Lee W.S.
        • et al.
        Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in adults with haematological malignancies: a phase 3, randomised, clinical trial and post-hoc efficacy analysis.
        Lancet Infect Dis. 2019; 19: 988-1000
      6. Neumann P.J. Sanders G.D. Russell L.B. Siegel J.E. Ganiats T.G. Cost-Effectiveness in Health and Medicine. Oxford University Press, Oxford, United Kingdom2016
        • Brisson M.
        • Van de Velde N.
        • De Wals P.
        • Boily M.C.
        Estimating the number needed to vaccinate to prevent diseases and death related to human papillomavirus infection.
        CMAJ. 2007; 177: 464-468
      7. Guidance for health economics studies presented to the Advisory Committee on Immunization Practices (ACIP), 2019 update, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
        • Linley L.
        • Johnson A.S.
        • Song R.
        • et al.
        Estimated HIV incidence and prevalence in the United States: 2014-2018. Centers for Disease Control and Prevention.
        https://stacks.cdc.gov/view/cdc/87841
        Version: 25(1)
        Date: 2020
        Date accessed: October 3, 2022
        • Lesko C.R.
        • Cole S.R.
        • Miller W.C.
        • et al.
        Ten-year survival by race/ethnicity and sex among treated, HIV-infected adults in the United States.
        Clin Infect Dis. 2015; 60: 1700-1707
        • Habel L.A.
        • Ray G.T.
        • Silverberg M.J.
        • et al.
        The epidemiology of herpes zoster in patients with newly diagnosed cancer.
        Cancer Epidemiol Prev Biomark. 2013; 22: 82-90
        • Hill H.A.
        • Elam-Evans L.D.
        • Yankey D.
        • Singleton J.A.
        • Kang Y.
        Vaccination coverage among children aged 19-35 months—United States, 2017.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 1123
        • Buchan S.A.
        • Daneman N.
        • Wang J.
        • et al.
        Incidence of hospitalizations and emergency department visits for herpes zoster in immunocompromised and immunocompetent adults in Ontario, Canada, 2002-2016.
        Clin Infect Dis. 2020; 71: 22-29
        • Li Q.
        • Chen S.Y.
        • Burstin S.J.
        • Levin M.J.
        • Suaya J.A.
        Cost of herpes zoster in patients with selected immune-compromised conditions in the United States.
        Open Forum Infect Dis. 2016; 3: ofw067
      8. 1996 through 2017 childhood varicella vaccination coverage trend report. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.
        • Lal H.
        • Cunningham A.L.
        • Godeaux O.
        • et al.
        Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults.
        N Engl J Med. 2015; 372: 2087-2096
        • Chiyaka E.T.
        • Nghiem V.T.
        • Zhang L.
        • Deshpande A.
        • Mullen P.D.
        • Le P.
        Cost-effectiveness of herpes zoster vaccination: a systematic review.
        Pharmacoeconomics. 2019; 37: 169-200
        • Boutry C.
        • Hastie A.
        • Diez-Domingo J.
        • et al.
        The adjuvanted recombinant zoster vaccine confers long-term protection against herpes zoster: interim results of an extension study of the pivotal phase 3 clinical trials ZOE-50 and ZOE-70.
        Clin Infect Dis. 2022; 74: 1459-1467