title: Is herpes zoster vaccination likely to be cost-effective in Canada?
abstract: OBJECTIVE
  To synthesize the current literature detailing the cost-effectiveness of the herpes zoster (HZ) vaccine, and to provide Canadian policy-makers with cost-effectiveness measurements in a Canadian context.
  
  
  METHODS
  This article builds on an existing systematic review of the HZ vaccine that offers a quality assessment of 11 recent articles. We first replicated this study, and then two assessors reviewed the articles and extracted information on vaccine effectiveness, cost of HZ, other modelling assumptions and QALY estimates. Then we transformed the results into a format useful for Canadian policy decisions. Results expressed in different currencies from different years were converted into 2012 Canadian dollars using Bank of Canada exchange rates and a Consumer Price Index deflator. Modelling assumptions that varied between studies were synthesized. We tabled the results for comparability.
  
  
  RESULTS
  The Szucs systematic review presented a thorough methodological assessment of the relevant literature. However, the various studies presented results in a variety of currencies, and based their analyses on disparate methodological assumptions. Most of the current literature uses Markov chain models to estimate HZ prevalence. Cost assumptions, discount rate assumptions, assumptions about vaccine efficacy and waning and epidemiological assumptions drove variation in the outcomes. This article transforms the results into a table easily understood by policy-makers.
  
  
  CONCLUSIONS
  The majority of the current literature shows that HZ vaccination is cost-effective at the price of $100,000 per QALY. Few studies showed that vaccination cost-effectiveness was higher than this threshold, and only under conservative assumptions. Cost-effectiveness was sensitive to vaccine price and discount rate.
authors.affiliation: University of Manitoba, Faculty of Medicine, Department of Community Health. umpedena@cc.umanitoba.ca.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Peden
authors.forename: Stephenson B
authors.initials: SB
authors.lastname: Strobel
authors.forename: Evelyn L
authors.initials: EL
authors.lastname: Forget
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D006562:Herpes Zoster / Q000191:economics / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000191:economics*; D006801:Humans; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*
chemical_list: D053061:Herpes Zoster Vaccine
keywords: Review; cost-benefit analysis; public policy