title: Cost-effectiveness of vaccination against herpes zoster in adults aged over 60 years in Belgium.
abstract: OBJECTIVE
  To assess the cost-effectiveness of vaccinating all or subgroups of adults aged 60 to 85 years against herpes zoster.
  
  
  METHODS
  A deterministic compartmental static model was developed (in freeware R), in which cohorts can acquire herpes zoster according to their age in years. Surveys and database analyses were conducted to obtain as much as possible Belgian age-specific estimates for input parameters. Direct costs and Quality-Adjusted Life-Year (QALY) losses were estimated as a function of standardised Severity Of Illness (SOI) scores (i.e. as a function of the duration and severity of herpes zoster disease).
  
  
  RESULTS
  Uncertainty about the average SOI score for a person with herpes zoster, the duration of protection from the vaccine, and the population that can benefit from the vaccine, exerts a major impact on the results: under assumptions least in favour of vaccination, vaccination is not cost-effective (i.e. incremental cost per QALY gained >€48,000 for all ages considered) at the expected vaccine price of €90 per dose. At the same price, but under assumptions most in favour of vaccination, vaccination is found to be cost-effective (i.e. incremental cost per QALY gained <€5500 for all ages considered). Vaccination of age cohort 60 seems more cost-effective than vaccination of any older age cohort in Belgium.
  
  
  CONCLUSIONS
  If the vaccine price per dose drops to €45, HZ vaccination of adults aged 60-64 years is likely to be cost-effective in Belgium, even under assumptions least in favour of vaccination. Unlike previous studies, our analysis acknowledged major methodological and model uncertainties simultaneously and presented outcomes for 26 different target ages at which vaccination can be considered (ages 60-85).
authors: Center for Health Economics Research and Modeling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. joke.bilcke@ua.ac.be
authors: Joke
authors: J
authors: Bilcke
authors: Christiaan
authors: C
authors: Marais
authors: Benson
authors: B
authors: Ogunjimi
authors: Lander
authors: L
authors: Willem
authors: Niel
authors: N
authors: Hens
authors: Philippe
authors: P
authors: Beutels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D006562:Herpes Zoster / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage* / Q000191:economics* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D014611:Vaccination / Q000191:economics*
chemical_list: D053061:Herpes Zoster Vaccine