Old Vaccine, New Vaccine: Cost Analysis Says, 'Go New!' for Shingles

When new vaccines enter the market, health care providers and patients always have questions about what to do. Such is the case with the new vaccine for shingles. A primary concern is always patient safety and vaccine effectiveness, but the Advisory Committee on Immunization Practices (ACIP) also considers cost.

Researchers from a clinic in Cleveland, Ohio have published a study of cost-effectiveness of adjuvanted herpes zoster subunit vaccine in older adults in the journal JAMA Internal Medicine. Their findings, using conservative assumptions, indicate that the new vaccine will probably cost less overall than the older, live vaccine. More importantly, they report a high probability of good value.

The reason a new vaccine has been needed since the live vaccine was FDA-approved in 2006 is that the live attenuated herpes zoster vaccine (ZVL) has not been 100% effective, and its effectiveness wanes over 10 years.

Researchers developed the adjuvanted H as the subunit vaccine (HZ/su) to improve effectiveness. Clinical trials have shown that it reduced the incidence of shingles by 97% in adults aged 50 years or older, and it also had high effectiveness (> 90%) in people older than 70.

The researchers conducted their research before the new virus was approved. Using a proposed price of $280 for the 2-shot series, the researchers looked at a number of factors in conducted sensitivity analysis. When they compared ZVL to HZ/su with regard to efficacy generation, price, and probability of having postherpetic neuralgia for a year or more, HZ/su was comparable or better than the older vaccine.

When they compared ZVL to HZ/su in no vaccination individuals, HZ/su outperformed the older vaccine with wide margins based on significantly greater effectiveness. The researchers also indicated that if the price of HZ/su was less than $160 per series, it would actually save money—not break even—compared with no vaccine at all.

The researchers noted that HZ/su's 2-dose series may be a barrier to vaccination. Pharmacists who administer this vaccine need to work with patients to ensure they return in approximately 2 months for their second dose.

Reference

Le P, Rothberg MB. Cost-effectiveness of the adjuvanted herpes zoster subunit vaccine in older adults. JAMA Intern Med. 2018 Feb 1;178(2):248-258.