title: Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review.
abstract: OBJECTIVE
  The objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN).
  
  
  METHODS
  We searched MEDLINE and EMBASE databases for eligible studies published prior to November 2013. We extracted information regarding model structure, model input parameters, and study results. We compared the results across studies by projecting the health and economic impacts of vaccinating one million adults over their lifetimes.
  
  
  RESULTS
  We identified 15 cost-effectiveness studies performed in North America and Europe. Results ranged from approximately US$10,000 to more than US$100,000 per quality-adjusted life years (QALY) gained. Most studies in Europe concluded that zoster vaccination is likely to be cost-effective. Differences in results among studies are largely due to differing assumptions regarding duration of vaccine protection and a loss in quality of life associated with HZ and to a larger extent, PHN. Moreover, vaccine efficacy against PHN, age at vaccination, and vaccine cost strongly influenced the results in sensitivity analyses.
  
  
  CONCLUSIONS
  Most studies included in this review shows that vaccination against HZ is likely to be cost-effective. Future research addressing key model parameters and cost-effectiveness studies in other parts of the world are needed.
authors.affiliation: Global Health Outcomes, Merck & Co., Inc., West Point, PA, USA. Electronic address: kkawai8@gmail.com.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Market Access and Economics, Sanofi Pasteur MSD, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Preaud
authors.affiliation: Department of Market Access and Economics, Sanofi Pasteur MSD, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Baron-Papillon
authors.affiliation: Department of Market Access and Economics, Sanofi Pasteur MSD, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Largeron
authors.affiliation: Global Health Outcomes, Merck & Co., Inc., West Point, PA, USA.
authors.forename: Camilo J
authors.initials: CJ
authors.lastname: Acosta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005060:Europe; D006562:Herpes Zoster / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000517:prevention & control*; D009656:North America; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
chemical_list: D053061:Herpes Zoster Vaccine
keywords: Cost-effectiveness; herpes zoster; postherpetic neuralgia; shingles; vaccination; vaccine