Assessing the potential effects and cost-effectiveness of programmatic herpes zoster vaccination of elderly in the Netherlands.
BACKGROUND
Herpes zoster (HZ) is a painful disease affecting a considerable part of the elderly. Programmatic HZ vaccination of elderly people may considerably reduce HZ morbidity and its related costs, but the extent of these effects is unknown. In this article, the potential effects and cost-effectiveness of programmatic HZ vaccination of elderly in the Netherlands have been assessed according to a framework that was developed to support evidence-based decision making regarding inclusion of new vaccines in the Dutch National Immunization Program.


METHODS
An analytical framework was used combining a checklist, which structured relevant data on the vaccine, pathogen and disease, and a cost-effectiveness analysis. The cost-effectiveness analysis was performed from a societal perspective, using a Markov-cohort-model. Simultaneous vaccination with influenza was assumed.


RESULTS
Due to the combination of waning immunity after vaccination and a reduced efficacy of vaccination at high ages, the most optimal cost-effectiveness ratio (21716 euro per QALY) for HZ vaccination in the Netherlands was found for 70-year olds. This estimated ratio is just above the socially accepted threshold in the Netherlands of 20000 euro per QALY. If additional reduction of postherpetic neuralgia was included, the cost-effectiveness ratio improved (approximately 10000 euro per QALY) but uncertainty for this scenario is high.


CONCLUSIONS
Vaccination against HZ at the age of 70 years seems marginally cost-effective in the Netherlands. Due to limited vaccine efficacy a considerable part of the disease burden caused by HZ will remain, even with optimal acceptance of programmatic vaccination.
van Lier
Alies
A
Department of Epidemiology and Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. alies.van.lier@rivm.nl
van Hoek
Albert Jan
AJ
Opstelten
Wim
W
Boot
Hein J
HJ
de Melker
Hester E
HE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D055815:Young Adult
D053061:Herpes Zoster Vaccine