Cost-effectiveness of herpes zoster vaccination in patients with rheumatoid arthritis

To assess the cost-effectiveness of vaccinating patients with rheumatoid arthritis (RA) with the adjuvanted recombinant zoster vaccine (RZV), compared with no vaccination.

To predict health gains and costs from vaccination, we developed a decision-analytic Markov model with five health states: no herpes zoster, herpes zoster (HZ), postherpetic neuralgia (PHN), recovered from HZ and death. The model follows a hypothetical cohort of 10 000 patients with RA over a lifetime perspective and records events of HZ and PHN, along with quality-adjusted life years (QALYs) and costs from a healthcare perspective. Costs and health effects were discounted with 4% annually. Model inputs were collected from published literature and publicly available sources. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), expressed as EUR per QALY, compared with a cost-effectiveness threshold of EUR 23 650 per QALY. We performed one-way and probabilistic sensitivity analyses.

Vaccination led to a reduction of 2550 cases of HZ and 1303 cases of PHN per 10 000 patients with RA vaccinated, resulting in an ICER of EUR 11 205/QALY. One-way sensitivity analyses revealed that the results were particularly sensitive to changes in the probability of developing PHN as a sequela of HZ. The probabilistic analysis indicated that the RZV had a 98% probability of being cost-effective at the assumed threshold value.

Vaccinating patients with RA using RZV results in better health at higher cost compared with no vaccination. Under the assumptions made, vaccination is likely to be considered cost-effective for patients with RA.