The new recombinant zoster vaccine (RZV) is more cost-effective than the live attenuated vaccine according to a new study that supports U.S. Advisory Committee on Immunization Practices recommendations for preferred use of the newer vaccine.

Researchers from the University of Michigan in Ann Arbor and the CDC in Atlanta evaluated the cost-effectiveness of two-dose vaccination with RZV, marketed as Shingrix, compared with zoster vaccine live (ZVL), marketed as Zostavax, and no vaccination. The study team also calculated the cost-effectiveness of vaccination with RZV for persons who have previously received ZVL and the cost-effectiveness of preferential vaccination with RZV over ZVL.

Results of the simulation (state-transition) model using U.S. epidemiologic, clinical, and cost data were published in Annals of Internal Medicine.

To reach their conclusions, researchers used a hypothetical cohort of immunocompetent U.S. adults aged 50 years or older, looking at lifetime effects from a societal and healthcare-sector perspective. Defined as the primary outcome measure was incremental cost-effectiveness ratio (ICER).

Results indicate that, for vaccination with RZV compared with no vaccination, ICERs ranged by age from $10,000 to $47,000 per quality-adjusted life-year (QALY), using a societal perspective and assuming 100% completion of the two-dose RZV regimen.

For older people, i.e., those aged 60 years or older, ICERs were less than $60,000 per QALY, the study notes. In fact, it adds, vaccination with ZVL was dominated by vaccination with RZV for all age groups aged 60 years or older.

“Results were most sensitive to changes in vaccine effectiveness, duration of protection, herpes zoster incidence, and probability of postherpetic neuralgia,” the researchers write, adding that vaccination with RZV after previous administration of ZVL yielded an ICER of less than $60,000 per QALY for persons aged 60 years or older. “In probabilistic sensitivity analyses, RZV remained the preferred strategy in at least 95% of simulations, including those with 50% completion of the second dose,” according to the article.

The authors said their study was limited because of little data on risk for serious adverse events, adherence to the recommended two-dose RSV regimen, and probability of recurrent zoster. They concluded, however, “Vaccination with RZV yields cost-effectiveness ratios lower than those for many recommended adult vaccines, including ZVL. Results are robust over a wide range of plausible values.”

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