Background
Methods
Search strategy
Study selection
Data extraction and synthesis
Results
Search results and quality assessment
Study characteristics
Varicella vaccination
Study | Country | Model type | Accounting for herd protection | Impact of varicella vaccination on HZ incidence | Time horizon | Type of economic evaluation | Perspective | Discount rate (costs/health effects) | Costing year and currency | Funding source |
---|---|---|---|---|---|---|---|---|---|---|
Banz et al. [35] | Germany | Dynamic | Yes | No | 30 years | CC | Health care payer; societal | 5 %/0 % | 1999 EUR | Industry |
Banz et al. [51] | Switzerland | Dynamic | Yes | No | 30 years | CC; CEA | Health care payer; societal | 5 %/0 % | 2008 CHF | Industry |
Beutels et al. [37] | Germany | Static | No | No | 70 years | CC; CEA | Health care payer; societal | 5 %/5 % | 1995 DEM | Independent |
Bilcke et al. [30] | Belgium | Dynamic | Yes | Depending on the type of analysis | Various | CEA; CUA | Health care payer | 3 %/1.5 % | 2010a EUR | Independent |
Bonanni et al. [36] | Italy | Dynamic | Yes | No | 30 years | CC | Health care payer; societal | 3 %/0 % | 2007a EUR | Industry |
Brisson et al. [31] | Canada | Dynamic | Yes | Yes (only in a separate analysis) | 30 years | CC; CEA | Health care payer; societal | 3 %/3 % | 1997/1998 CAD | Independent |
Brisson et al. [32] | England and Wales | Dynamic | Yes | Yes | 80 years | CUA | Health care payer; societal | 3 %/3 % | 2001 GBP | Independent |
Coudeville et al. [52] | France | Dynamic | Yes | No | 30 years | CC | Health care payer; societalb | 5 %/NA | 1995 FRF | Industry |
Coudeville et al. [53] | Italy | Dynamic | Yes | No | 50 years | CC | Health care payer; societal | 3 %/NA | 2002 EUR | Industry |
Coudeville et al. [54] | France and Germany | Dynamic | Yes | No | 50 years | CC; CEA | Health care payer; societal | 3 %/3 % | 2002 EUR | Industry |
Diez Domingo et al. [55] | Spain | Static | No | No | 20 years | CC | Health care payer; societal | 5 %/NA | 1994 PTA | Independent |
Getsios et al. [56] | Canada | Static | No | No | 70 years | CEA; CUA | Health care payer; societal | 3 %/3 % | 1998 CAD | Independent |
Ginsberg & Somekh [57] | Israel | Static | Partially | No | Lifetime | CC | Health care payer; societal | 3 %/NA | 2002 USD | Independent |
Hammerschmidt et al. [58] | Germany | Dynamic | Yes | No | 30 years | CC | Health care payer; societal | Not specified (probably 5 % for costs) | 1999/2006c EUR | Industry |
Huse et al. [59] | USA | Static | No | No | 24 years | CC | Societal | 5 %/5 % | 1991 USD | Industry |
Lenne et al. [60] | Spain | Dynamic | Yes | No | 50 years | CC; CEA | Health care payer; societal | 3 %/0 % | 2004 EUR | Industry |
Lieu et al. [61] | USA | Dynamic | Yes | No | 30 years | CC; CEA | Health care payer; societal | 5 %/5 % | 1990 USD | Independent |
Preblud et al. [62] | USA | Static | No | No | 30 years | CC | Health care payer; societal | 5 %/0 % | 1984 USD | Independent |
Scuffham et al. [63] | New Zealand | Static | No | No | 30 years | CC | Health care payer; societal | 5 %/5 % | 1997 NZD | Industry |
Scuffham et al. [34] | Australia | Static | No | No | 30 years | CEA | Health care payer | 5 %/5 % | 1996/1997 AUD | Independent |
Thiry et al. [64] | Italy | Static | No | No | 100 years | CC; CEA | Health care payer; societal | 3 %/3 % | 2002 EUR | Industry |
van Hoek et al. [33] | UK | Dynamic | Yes | Yes | Infinite | CUA | Health care payer | 3.5 %/3.5 % | 2007 GBP | Independent |
Zhou et al. [29] | USA | Static | No | No | Lifetime | CC; CUA | Health care payer; societal | 3 %/3 % | 2006 USD | Industry |
Study | Age at vaccination | Vaccine efficacy | Waning (per year) | Vaccination coverage | Vaccination costs per dose (2010 EUR; German price level) |
---|---|---|---|---|---|
Banz et al. [35] | 15 months; 11–12 years | 86 % | 0.5 % | 85 % (children); 30 % (adolescents) | EUR 65.93 (children)a; EUR 71.38 (adolescents)a |
Banz et al. [51] | 1-2 years; 11–15 years | 95 % | 0.5 % | 70 % (children); 85 % (adolescents) | EUR 42.20 (children)a; EUR 56.65 (adolescents)a |
Beutels et al. [37] | 15 months; 12 years | 90 % | Waning in 15 % of the protected vaccineesb | 70 % | EUR 50.82a |
Bilcke et al. [30] | 1 year (1st dose); 4, 6 or 11 years (2nd dose) | Data from van Hoek et al. 2012 | Data from van Hoek et al. 2012 | 50 % or 95 % (1st dose); 50 %, 80 % or 90 % (2nd dose) | EUR 44.92a |
Bonanni et al. [36] | 12-18 months; 13 years | 90 % (1st dose); 93 % (2nd dose) | 3 % | 85 % | EUR 46.81a,c |
Brisson et al. [31] | 12 months; 12 years | 93 % | 3.1 % | 90 % (infants); 80 % (adolescents) | EUR 51.42 (children)a; EUR 68.57 (adolescents)a |
Brisson et al. [32] | Infants; 11 years | 93 % | 3.1 % | 90 % (infants); 80 % (adolescents) | EUR 44.32 (children)a; EUR 59.10 (adolescents)a |
Coudeville et al. [52] | <6 years | 90 % | Waning in 15 % of the protected vaccineesb | 80 % | EUR 18.11c,d |
Coudeville et al. [53] | 12-36 months | 97 % | 3.1 % | 45 %-90 % | EUR 52.00a,c |
Coudeville et al. [54] | 12-36 months | 97 % | 3.1 % | 45 %-90 % | EUR 64.08 (Germany)a,c; EUR 59.56 (France)a,c |
Diez Domingo et al. [55] | 15 months | 90 % | No waning | 95 % | EUR 37.11 |
Getsios et al. [56] | 12 months | 90 % | Waning in 15 % of the protected vaccineesb | 85 % | EUR 60.25a,d |
Ginsberg & Somekh [57] | 12 months | 87.6 % | 3.1 % | 94 % | EUR 8.01a,c,d |
Hammerschmidt et al. [58] | 11-23 months (catch-up of 2–17 year olds) | 86 % (1-dose schedule); 95 % (2-dose schedule) | 0.5 % | 90 % (1st dose); 80 % (2nd dose); 30 % (catch-up); 10 % (comparator) | EUR 47.38 (monovalent vaccine); EUR 47.92 (varicella-attributable cost of the MMRV vaccine) |
Huse et al. [59] | 15 months | 95 % | No waning | Not specified | EUR 62.31a |
Lenne et al. [60] | 1-2 years | 97 % | 3,1 % | 97,15 % | EUR 42.54a |
Lieu et al. [61] | <6 years | 90 % | Waning in 15 % of the protected vaccineesb | 97 % | EUR 54.12a |
Preblud et al. [62] | 15 months | 90 % | No waning | 90 % | EUR 25.53 |
Scuffham et al. [63] | 15 months | 95 % | No waning | 80 %; 10 % (comparator) | EUR 45.94 |
Scuffham et al. [34] | 12 months; 12 years | 95 % | No waning | 80 % (infants); 50-75 % (adolescents) | EUR 42.26 |
Thiry et al. [64] | 11 years | 93,12 % | 3.1 % | 60 % | EUR 52.36a |
van Hoek et al. [33] | 1 year (1st dose); 3 years (2nd dose) | 89-96 % (1st dose); 93-96 % (2nd dose) | 1.5-6.7 % (1st dose); 0.05-2.6 % (2nd dose) | 90 % (1st dose); 80 % (2nd dose) | EUR 41.19 |
Zhou et al. [29] | Children | 80 % (1-dose schedule)e; 93 % (2-dose schedule) | No waning | Age-specific coverage rates; 95 % (2nd dose) | EUR 49.90 (monovalent vaccine)f; EUR 65.64 (MMRV vaccine)f |
Herpes zoster vaccination
Study | Country | Model type | Time horizon | Type of economic evaluation | Perspective | Discount rate (costs/health effects) | Costing year and currency | Funding source |
---|---|---|---|---|---|---|---|---|
Annemans et al. [65] | Belgium | Static | Lifetime | CEA; CUA | Health care payer (with and without co-payments); societal | 3 %/1.5 % | 2007 EUR | Industry |
Bilcke et al. [38] | Belgium | Static | Lifetime | CEA; CUA | Health care payer | 3 %/1.5 % | 2009a EUR | Independent |
Bilcke et al. [30] | Belgium | Dynamicb | Various | CEA; CUA | Health care payer | 3 %/1.5 % | 2011a EUR | Independent |
Bresse et al. [66] | France | Static | Lifetime | CEA; CUA | Health care payer (with and without co-payments) | 4 %/4 %c | 2010 EUR | Industry |
Brisson et al. [67] | Canada | Static | Lifetime | CUA | Health care payer | 5 %/5 % | 2005 CAD | Industry |
de Boer et al. [40] | Netherlands | Static | Up to 41 years | CUA | Health care payer; societal | 4 %/1.5 % | 2010 EUR | Independent |
Edmunds et al. [68] | England and Wales | Static | Lifetime | CEA; CUA | Health care payer | 3 %/3 % | 1998 GBP | Independent |
Hornberger et al. [28] | USA | Static | 30 years | CUA | Societal | 3 %/3 % | 2006 USD | Independent |
Moore et al. [69] | UK | Static | Lifetime | CEA; CUA | Health care payer; societal | 3.5 %/3.5 % | 2006 GBP | Industry |
Najafzadeh et al. [26] | Canada | Static | Lifetime | CUA | Health care payer | 5 %/5 % | 2008 CAD | Independent |
Pellissier et al. [70] | USA | Static | Lifetime | CUA | Health care payer; societal | 3 %/3 % | 2006 USD | Industry |
Rothberg et al. [42] | USA | Static | Not specified | CUA | Societal | 3 %/3 % | 2005 USD | Independent |
Szucs et al. [71] | Switzerland | Static | Lifetime | CEA; CUA | Health care payer; societal | 3.5 %/1.5 % | 2010a CHF | Industry |
Ultsch et al. [39] | Germany | Static | Lifetime | CEA; CUA | Health care payer; societal | 3 %/3 % | 2010 EUR | Independent |
van Hoek et al. [72] | England and Wales | Static | Lifetime | CUA | Health care payer | 3.5 %/3.5 % | 2006 GBP | Independent |
van Hoek et al. [33] | UK | Dynamicb | Infinite | CUA | Health care payer | 3.5 %/3.5 % | 2007 GBP | Independent |
van Lier et al. [41] | Netherlands | Static | Not specified | CUA | Health care payer; societal | 4 %/1.5 % | 2008 EUR | Independent |
Study | Age at vaccination (in years) | Vaccine efficacy against HZ | Waning or duration of protection | Vaccination coveragea | Vaccination costs per dose (2010 EUR, German price level) |
---|---|---|---|---|---|
Annemans et al. [65] | 50+ | 37.6-63.9 %, age-dependent | No waningb | 20 % | EUR 141.39c |
Bilcke et al. [38] | 60-85 | Age-dependent (values are reported graphically only) | Consideration of waning depends on the choice of scenario | 30 % | EUR 106.95d |
Bilcke et al. [30] | 50 or 60 | 77 %e | Duration of protection of 7.5 years or lifelong protection | 30 % or 70 % | EUR 103.38d |
Bresse et al. [66] | 65+ | 18-64 %, age-dependent | 4.15 % per year and vaccine efficacy was set to zero after 10 years | 20 % | EUR 117f |
Brisson et al. [67] | 50-80 | 26-75 %, age-dependent | No waningb | Not specified | EUR 108.60 |
de Boer et al. [40] | 60-75 | 41.2-69.4 %, age-dependent | 8.3 % per year (= duration of protection of 12 years) | Not specified | EUR 89.10d |
Edmunds et al. [68] | 65 | 30-70 % | Duration of protection of 2.5 years to life long | 60 % | EUR 122.13d,g |
Hornberger et al. [28] | 69 | Modelled by applying age-specific incidence of HZ in vaccine and placebo-treated arm of the clinical study, age-dependent | Duration of protection of 30 years | Not specified | EUR 43.85-438.46d,h |
Moore et al. [69] | 50+ | 37.6-63.9 %, age-dependent | No waningb | 40 % | EUR 143.28d |
Najafzadeh et al. [26] | 60+ | Modelled by applying age-specific incidence of HZ in vaccine and placebo-treated arm of the clinical study, age-dependent | 4.5 % per year | Not specified | EUR 101.83 |
Pellissier et al. [70] | 60+ | 27.1-69.8 %, age-dependent | No waningb | Not specified | EUR 147.32d |
Rothberg et al. [42] | 60-80 | Age-dependent | Waning considered but not quantified | Not specified | EUR 134.74d |
Szucs et al. [71] | 70-79 | 37.60-63.9 %, age-dependent | No waningb | 20 % | EUR 143.09d |
Ultsch et al. [39] | 50-80 | 13.22-69.8 %, age-dependent | 8.3 % per year following 10 years of stable vaccine efficacy | 20 % | EUR 147.48d |
van Hoek et al. [72] | 60-75 | 31-95 % (based on 15 different take and waning scenarios), age-dependent | Duration of protection of 3.6-100 years (based on 15 different take and waning scenarios) | 73.5 % | EUR 88.36d |
van Hoek et al. [33] | 75 | Data from van Hoek et al. [72] | Data from van Hoek et al. [72] | 70 % | EUR 86.37d |
van Lier et al. [41] | 60-80 | Data from van Hoek et al. [72] | Duration of protection of 7.5 years | 75 % | EUR 81.54d |
Results of the included studies
Varicella vaccination
Study | Age at vaccination | Dose schedule | Comparator | Health care payer perspective | Societal perspective |
---|---|---|---|---|---|
Banz et al. [35] | 15 months | 1 | No vaccination | BCR 1.75 | BCR 4.12 |
11-12 yearsa | 1 | No vaccination | BCR 1.13 | BCR 8.44 | |
combined | 1 | No vaccination | BCR 1.70 | BCR 4.10 | |
Banz et al. [51] | 1-2 years | 2 | 2-dose vaccination at 11–15 yearsa | BCR 0.30; EUR 856/LYG | BCR 1.29 |
Beutels et al. [37] | 15 months | 1 | No vaccination | BCR 0.82; EUR 14,700/LYG | BCR 4.60 |
12 yearsa | 1 | No vaccination | BCR 1.94 | BCR 6.02 | |
Bilcke et al. [30] | 1 year (95 % coverage) | 1 | No vaccination | EUR 550–14,140/QALY | NA |
1 year (1st dose, 95 % coverage); 4 years (2nd dose, 90 % coverage) | 2 | No vaccination | EUR 5,240-31,942/QALY | NA | |
1 year (1st dose, 95 % coverage); 11 years (2nd dose, 80 % coverage) | 2 | No vaccination | EUR 5,043-29,775/QALY | NA | |
1 year (1st dose, 50 % coverage); 4 years (2nd dose, 50 % coverage) | 2 | No vaccination | EUR 3,345-23,240/QALY | NA | |
All vaccination options (including and excluding additional HZ vaccination) | 2 | No vaccination | Net QALY loss for many time horizonsb; EUR 36,256-135,961/LYGb | NA | |
Bonanni et al. [36] | 12-18 months | 2 | No vaccination | BCR 0.67 | BCR 3.47 |
13 years | 2 | No vaccination | BCR 0.36 | BCR 2.60 | |
Brisson et al. [31] | 12 months | 1 | No vaccination | BCR 0.61; EUR 38,142/LYG | BCR 5.24 |
12 months | 1 | No vaccination | BCR 0.59c; EUR 40,193/LYGc | BCR 5.09c | |
12 months | 1 | No vaccination | BCR 0.16b; EUR 101,296/LYGb | NA | |
12 yearsa | 1 | No vaccination | BCR 0.73; EUR 15,863/LYG | BCR 4.44 | |
Brisson et al. [32] | Infants | 1 | No vaccination | Net QALY lossb | Net QALY lossb |
11 yearsa | 1 | No vaccination | EUR 26,110/QALYb | Cost-savingb | |
Coudeville et al. [52] | <6 years | 1 | No vaccination | Net benefit EUR 326.8 million | NA |
Coudeville et al. [53] | 12-36 months | 1 | No vaccination | BCR 1.20 at high vaccination coverage | BCR 3.50 at high vaccination coverage |
Coudeville et al. [54] | 12-36 months | 1 | No vaccination | Cost-saving at high vaccination coverage (Germany 51 %; France 6.7 %); EUR 6.960/LYG at low vaccination coverage (France; cost-saving in Germany) | Cost-saving at high vaccination coverage (Germany 61 %; France 60 %) |
DIez Domingo et al. [55] | 15 months | 1 | No vaccination | BCR 0.54 | BCR 1.61 |
Getsios et al. [56] | 12 months | 1 | No vaccination | EUR 71,722/QALY; EUR 36/varicella case avoided | Cost-saving |
Ginsberg & Somekh [57] | 12 months | 1 | No vaccination | BCR 1.63 | BCR 19.33 |
Hammerschmidt et al. [58] | 11-23 months (including a catch-up of 2–17 year oldsa) | 2 (1 dose for catch-up) | 1-dose vaccination at 12–15 yearsa | BCR 1.08 | BCR 2.56 |
Huse et al. [59] | 15 months | 1 | No vaccination | NA | Cost-saving (net benefit of EUR 86.28 per vaccinee) |
Lenne et al. [60] | 1-2 years | 1 | No vaccination | BCR 0.91; EUR 5,202/LYG | BCR 3.70 |
Lieu et al. [61] | <6 years | 1 | No vaccination | BCR 0,90; EUR 21,648/LYG; EUR 5.68/varicella case prevented | BCR 5.40 |
Preblud et al. [62] | 15 months | 1 | No vaccination | BCR 0.30 | BCR 6.90 (including home care costs) |
Scuffham et al. [63] | 15 months | 1 | No routine vaccination but low private coverage | BCR 0.67 | BCR 2.79 |
Scuffham et al. [34] | 12 months | 1 | No vaccination | EUR 49.11/varicella case avoided; EUR 16,439/hospitalisation avoided | NA |
12 yearsa | 1 | No vaccination | EUR 404.81/varicella case avoided; EUR 26,791/hospitalisation avoided | NA | |
Thiry et al. [64] | 11 yearsa | 1 | No vaccination | BCR 0.54; EUR 26,988/LYG | BCR 2.17 |
van Hoek et al. [33] | 1 year (first dose); 3 years (second dose) | 2 | No vaccination | 41 % of the simulations below GBP 20,000/QALY (EUR 26,576/QALY)b; 50 % of the simulations below GBP 30,000/QALY (EUR 39,864/QALY)b | NA |
1 year (first dose); 3 years (second dose) + HZ vaccination of the elderly | 2 | No vaccination | 50 % of the simulations below GBP 20,000/QALY (EUR 26,576/QALY)b; 70 % of the simulations below GBP 30,000/QALY (EUR 39,864/QALY)b | NA | |
Zhou et al. [29] | Children | 1 | No vaccination | BCR 1.00 | BCR 4.37 |
Children | 2 | No vaccination | BCR 0.61 | BCR 2.73 | |
Children | 2 | 1-dose vaccination | BCR 0.13 | BCR 0.56; EUR 95,584/QALY |
Herpes zoster vaccination
Study | Age at vaccination (years) | Comparator | Health care payer perspective | Societal perspective |
---|---|---|---|---|
Annemans et al. [65] | 50+ | No vaccination | EUR 6,624/QALY; EUR 1,046/HZ case avoided; EUR 3,495-3,523/PHN case avoideda | EUR 6,822/QALY; EUR 1,077/HZ case avoided; EUR 3,600-3,629/PHN case avoideda |
60+ | No vaccination | EUR 6,809/QALY; EUR 1,310/HZ case avoided; EUR 3,942-3,969/PHN case avoideda | EUR 7,148/QALY; EUR 1,375/HZ case avoided; EUR 4,039-4,137/PHN case avoideda | |
65+ | No vaccination | EUR 7,184/QALY; EUR 1,560/HZ case avoided; EUR 4,176-4,336/PHN case avoideda | EUR 7,577/QALY; EUR 1,645/HZ case avoided; EUR 4,404-4,574/PHN case avoideda | |
60-64 | No vaccination | EUR 5,694/QALY; EUR 817/HZ case avoided; EUR 2,936-2,969/PHN case avoideda | EUR 5,867/QALY; EUR 842/HZ case avoided; EUR 3,025-3,059/PHN case avoideda | |
65-69 | No vaccination | EUR 5,412/QALY; EUR 873/HZ case avoided; EUR 2,967-2,991/PHN case avoideda | EUR 5,628/QALY; EUR 909/HZ case avoided; EUR 3,087-3,112/PHN case avoideda | |
60-69 | No vaccination | EUR 5,553/QALY; EUR 844/HZ case avoided; EUR 2,951-2,980/PHN case avoideda | EUR 5,747/QALY; EUR 874/HZ case avoided; EUR 3,054-3,085/PHN case avoideda | |
Bilcke et al. [38] | 60 | No vaccination | EUR 1,200-46,968/QALY; EUR 584–5,148/HZ case avoided | NA |
70 | No vaccination | EUR 2,200-70,496/QALY; EUR 1,239-8,603/HZ case avoided | NA | |
80 | No vaccination | EUR 3,824-126,793/QALY; EUR 2,867-17,353/HZ case avoided | NA | |
85 | No vaccination | EUR 5,272-291,240/QALY; EUR 4,451-42,164/HZ case avoided | NA | |
Bilcke et al. [30] | 50 or 60 | No vaccination | No results for a sole HZ vaccination reported; see Table 5 for results on combined varicella and HZ vaccination | NA |
Bresse et al. [66] | 65+ | No vaccination | EUR 11,480/QALY; EUR 2,479/HZ case avoided; EUR 4,101/PHN case avoidedb | NA |
70-79 | No vaccination | EUR 8,876/QALY; EUR 2,090/HZ case avoided; EUR 3,302/PHN case avoidedb | NA | |
Brisson et al. [67] | 50 | No vaccination | EUR 36,667/QALY | NA |
60 | No vaccination | EUR 26,563/QALY | NA | |
65 | No vaccination | EUR 24,002/QALY | NA | |
70 | No vaccination | EUR 22,924/QALY | NA | |
80 | No vaccination | EUR 33,153/QALY | NA | |
de Boer et al. [40] | 60 | No vaccination | EUR 40,050/QALY | EUR 33,901/QALY |
65 | No vaccination | EUR 34,440/QALY | EUR 33,511/QALY | |
70 | No vaccination | EUR 28,491/QALY | EUR 28,284/QALY | |
75 | No vaccination | EUR 28,506/QALY | EUR 28,506/QALY | |
Edmunds et al. [68] | 65 | No vaccination | EUR 5,435-100,700/QALYc | NA |
Hornberger et al. [28] | 69 | No vaccination | NA | From cost-saving up to EUR 250,470/QALYd |
Moore et al. [69] | 50+ | No vaccination | EUR 17,681/QALY; EUR 1,957/HZ case avoided; EUR 7,369-7,413/PHN case avoided | EUR 15,520/QALY; EUR 1,710/HZ case avoided; EUR 6,434-6,472/PHN case avoided |
50-54 | No vaccination | EUR 18,041/QALY | EUR 12,488/QALY | |
55-59 | No vaccination | EUR 16,182/QALY | EUR 12,124/QALY | |
60-64 | No vaccination | EUR 14,931/QALY | EUR 12,866/QALY | |
65-69 | No vaccination | EUR 13,967/QALY | EUR 13,638/QALY | |
70-74 | No vaccination | EUR 17,814/QALY | EUR 17,814/QALY | |
75-79 | No vaccination | EUR 20,352/QALY | EUR 20,352/QALY | |
80-84 | No vaccination | EUR 27,176/QALY | EUR 27,176/QALY | |
85-89 | No vaccination | EUR 45,799/QALY | EUR 45,799/QALY | |
90-94 | No vaccination | EUR 67,522/QALY | EUR 67,522/QALY | |
95-99 | No vaccination | EUR 100,562/QALY | EUR 100,562/QALY | |
100+ | No vaccination | EUR 140,125/QALY | EUR 140,125/QALY | |
Najafzadeh et al. [26] | 60+ | No vaccination | EUR 28,314/QALY | NA |
60-74 | No vaccination | EUR 24,002/QALY | NA | |
75+ | No vaccination | EUR 44,123/QALY | NA | |
Pellissier et al. [70] | 60+, general population | No vaccination | EUR 16,170/QALY | EUR 14,232/QALY |
60+, immunocompetent only | No vaccination | EUR 24,211/QALY | EUR 22,255/QALY | |
Rothberg et al. [42] | 60, male | No vaccination | NA | EUR 130,097/QALY |
60, female | No vaccination | NA | EUR 81,076/QALY | |
70, male | No vaccination | NA | EUR 59,794/QALY | |
70, female | No vaccination | NA | EUR 39,512/QALY | |
80, male | No vaccination | NA | EUR 173,224/QALY | |
80, female | No vaccination | NA | EUR 111,779/QALY | |
Szucs et al. [71] | 70-79 | No vaccination | EUR 13,743/QALY; EUR 3,565/HZ case avoided; EUR 8,334/PHN case avoided | CHF 15,361/QALY; CHF 3,985/HZ case avoided; EUR 9,315/PHN case avoided |
Ultsch et al. [39] | 50 | No vaccination | EUR 37,173/QALY; EUR 1,587/HZ case avoided; EUR 32,545/PHN case avoided | EUR 30,901/QALY; EUR 1,320/HZ case avoided; EUR 27,054/PHN case avoided |
55 | No vaccination | EUR 32,480/QALY; EUR 1,518/HZ case avoided; EUR 26,194/PHN case avoided | EUR 28,244/QALY; EUR 1,320/HZ case avoided; EUR 22,777/PHN case avoided | |
60 | No vaccination | EUR 30,212/QALY; EUR 1,525/HZ case avoided; EUR 22,337/PHN case avoided | EUR 28,146/QALY; EUR 1,419/HZ case avoided; EUR 20,809/PHN case avoided | |
65 | No vaccination | EUR 30,807/QALY; EUR 1,655/HZ case avoided; EUR 20,951/PHN case avoided | EUR 29,526/QALY; EUR 1,586/HZ case avoided; EUR 20,079/PHN case avoided | |
70 | No vaccination | EUR 42,190/QALY; EUR 2,732/HZ case avoided; EUR 22,813/PHN case avoided | EUR 41,942/QALY; EUR 2,716/HZ case avoided; EUR 22,679/PHN case avoided | |
75 | No vaccination | EUR 55,171/QALY; EUR 3,939/HZ case avoided; EUR 27,396/PHN case avoided | EUR 54,940/QALY; EUR 3,923/HZ case avoided; EUR 27,281/PHN case avoided | |
80 | No vaccination | EUR 92,734/QALY; EUR 9,433/HZ case avoided; EUR 35,717/PHN case avoided | EUR 92,541/QALY; EUR 9,414/HZ case avoided; EUR 35,643/PHN case avoided | |
van Hoek et al. [72] | 60 | No vaccination | EUR 36,302/QALY | NA |
65 | No vaccination | EUR 27,747/QALY | NA | |
70 | No vaccination | EUR 20,589/QALY | NA | |
75 | No vaccination | EUR 25,211/QALY | NA | |
van Hoek et al. [33] | 75 | No vaccination | 49 % of the simulations below GBP 20,000/QALY (EUR 26,576/QALY); 96 % of the simulations below GBP 30,000/QALY (EUR 39,864/QALY) | NA |
75 and 2-dose varicella vaccination of children | No vaccination | 50 % of the simulations below GBP 20,000/QALY (EUR 26,576/QALY); 70 % of the simulations below GBP 30,000/QALY (EUR 39,864/QALY) | NA | |
van Lier et al. [41] | 60 | No vaccination | EUR 39,577/QALY | EUR 37,638/QALY |
65 | No vaccination | EUR 30,514/QALY | EUR 30,514/QALY | |
70 | No vaccination | EUR 21,219/QALY | EUR 21,219/QALY | |
75 | No vaccination | EUR 23,779/QALY | EUR 23,779/QALY | |
80 | No vaccination | EUR 33,661/QALY | EUR 33,661/QALY |
Combined varicella and herpes zoster vaccination strategy
Discussion
Key findings
Varicella vaccination
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When ignoring the potential impact on HZ and adopting a health care payer perspective, universal childhood varicella vaccination was usually a cost-effective or even cost-saving strategy.
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When switching to a societal perspective, childhood varicella vaccination was found to be a cost-saving intervention.
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Vaccination of adolescents was found to be a cost-effective or cost-saving strategy. However, it remains unclear if adolescent vaccination is more or less cost-effective than childhood vaccination due to inconsistent study results.
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Taking the potential impact on HZ into account, it is doubtful that childhood varicella vaccination appears to be cost-effective, at least for several decades.
HZ vaccination
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In most studies, HZ vaccination was predicted to be cost-effective or marginally cost-effective.
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When considering both a payer and a societal perspective, the differences in results between the two perspectives decreased with increasing age at vaccination since indirect costs due to sick leave become less relevant in the elderly population.
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When waning of vaccine-induced immunity was modelled, cost-effectiveness of HZ vaccination was highly dependent on the age at vaccination. ICERs decreased with increasing age at vaccination up to a certain age, followed by a re-increase of the ICERs (U-shape) for older ages. Most results suggest that the optimal age for HZ vaccination is between 60 and 70 years or around 70 years. Furthermore, cost-effectiveness was dependent on the price of the vaccine, the duration of protection and the assumed cost-effectiveness threshold.