title: Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.
abstract: BACKGROUND
  The Advisory Committee on Immunization Practices recommends a single dose of herpes zoster (HZ) vaccine in persons aged 60 years or older, but the efficacy decreases to zero after approximately 10 years. A booster dose administered after 10 years might extend protection, but the cost-effectiveness of a booster strategy has not been examined.
  
  
  OBJECTIVE
  We aimed to determine the optimal schedule for HZ vaccine DESIGN: We built a Markov model to follow patients over their lifetime. From the societal perspective, we compared costs and quality-adjusted life years (QALYs) saved of 11 strategies to start and repeat HZ vaccine at different ages.
  
  
  METHODS
  Adults aged 60 years.
  
  
  METHODS
  HZ vaccine.
  
  
  METHODS
  Costs, quality-adjusted life years (QALYs), and incremental costs per QALY saved.
  
  
  RESULTS
  At a $100,000/QALY threshold, "vaccination at 70 plus one booster" was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of $36,648/QALY. "Vaccination at 60 plus two boosters" was more effective, but had an ICER of $153,734/QALY. In deterministic sensitivity analysis, "vaccination at 60 plus two boosters" cost < $100,000/QALY if compliance rate was > 67 % or vaccine cost was < $156 per dose. In probabilistic sensitivity analysis, "vaccination at 70 plus one booster" was preferred at a willingness-to-pay of up to $135,000/QALY.
  
  
  CONCLUSIONS
  Under current assumptions, initiating HZ vaccine at age 70 years with one booster dose 10 years later appears optimal. Future data regarding compliance with or efficacy of a booster could affect these conclusions.
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. lep@ccf.org.
authors.forename: Phuc
authors.initials: P
authors.lastname: Le
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006562:Herpes Zoster / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000191:economics*; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary / Q000191:economics* / Q000592:standards; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics
chemical_list: D053061:Herpes Zoster Vaccine
keywords: booster; cost-effectiveness; herpes zoster