Cost-effectiveness of herpes zoster vaccines in the U.S.: A systematic review

The purpose of this study was to conduct a systematic review to evaluate the cost-effectiveness evidence of herpes zoster vaccines in the U.S. A systematic literature review was undertaken for U.S. studies focused on the cost-effectiveness of herpes zoster vaccines. Eligibility criteria included studies that evaluated the cost-effectiveness of the recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL) and were published between 2015 and 2021. Article titles and abstracts were reviewed to identify relevant publications. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria for economic evaluations were used to evaluate the studies. Eleven published studies met inclusion and exclusion criteria. Seven studies compared RZV and ZVL. Four studies compared ZVL dosing regimens with or without a no vaccine option. All studies incorporated health system costs. Ten out of eleven (90.9%) studies conducted their analyses from a societal perspective and included indirect costs. For measurements of effectiveness, ten of eleven (90.9%) studies estimated quality-adjusted life years, four (36.4%) used shingles cases averted, two (18.2%) employed deaths prevented, and one (9.1%) measured life years saved. All studies that compared RZV with no vaccine found RZV to be a cost-effective strategy to prevent both shingles and post-herpetic neuralgia. Additionally, these analyses showed that RZV consistently dominated ZVL. Compliance with the second RZV dose was important for full benefit of the vaccine. The studies identified in this systematic review identified well-constructed cost-effectiveness analyses of herpes zoster vaccines in the U.S. RZV was more cost-effective than no vaccine or ZVL. This systematic review supports removal of ZVL from the U.S. market.