Cost-Effectiveness of Recombinant Zoster Vaccine (Shingrix) in US Adults Aged ≥50 Years

The recombinant zoster vaccine (RZV; Shingrix) was approved in 2017. In 2018, the vaccine appeared cost-effective based on available evidence and assumptions. Since then, new evidence has become available regarding long-term efficacy, completion of the 2-dose regimen, duration of immunity, and vaccine price.

We adapted a previously published Markov state-transition model to compare RZV with no vaccination among immunocompetent US adults aged 50, 60, 70 and 80 years. The model simulated annual transitions between health states including healthy, acute herpes zoster, postherpetic neuralgia, other complications, and death. Key updated parameters included age-specific efficacy, duration of immunity, completion of the 2-dose regimen, and 2025 vaccine pricing. Costs and outcomes were evaluated from a societal perspective over a lifetime horizon and discounted at 3% annually. We estimated cost-effectiveness by age to identify the optimal time to vaccinate.

The incremental cost-effectiveness ratio (ICER) for RZV was $161,162 per QALY at age 50, and $31,465, $16,457, and $19,230 per QALY at ages 60, 70, and 80, respectively. Vaccination was cost-effective for adults aged 60 years and older but not at age 50, using a willingness-to-pay threshold of $100,000/QALY. Results were most sensitive to vaccine price, herpes zoster incidence, and waning duration. Age-specific analysis showed that vaccination became cost-effective at approximately age 54 years.

RZV is cost-effective for adults aged 54 years and older. Continued assessment of long-term protection is needed to refine these estimates and evaluate the potential need for booster doses.