Abstract
Background
The new adjuvanted recombinant zoster vaccine (RZV) has shown higher vaccine efficacy for herpes zoster than the live-attenuated vaccine. While some European studies have assessed its cost-effectiveness, the economic impact of introducing it in the Swedish universal vaccination programme is unknown. In addition, the impact of introducing RZV on population health distribution is largely unknown. The aim of the current study was to assess the cost-effectiveness of the RZV if implemented in Sweden, and its impact on the distribution of health.
Methods
A decision-analytic model was used to estimate the health economic impact of introducing RZV in Sweden. Five-year age-cohorts were modelled between ages 65 to 100+, comparing the cost-effectiveness of RZV to no vaccine. Due to large differences in vaccine efficacy between RCT- and RWD-studies, two separate scenarios were analyzed using both types of data. The model was populated with Swedish register-based data and estimates from the literature. A lifetime time horizon was implemented, along with a healthcare payer perspective including out-of-pocket expenses, incorporating health care resource use due to HZ and related complications. Cost of the vaccine was set at market price and varied in additional analyzes. A three-percentage discount rate was applied to costs and outcomes. Differential quality-adjusted life years (QALYs) and uptake rates based on sex and educational level were incorporated into the model to estimate distributional health impacts. Incremental QALYs were put into comparison to incremental costs to estimate the cost-effectiveness.
Results
Preliminary results show that compared with no vaccination, RZV would not deemed cost-effective at a willingness-to-pay of 50,000 euro across cohorts. The vaccine price would have to drop by roughly 50% for the vaccine to be considered cost-effective. In addition, preliminary findings show that it would also lead to an increased health gap.
Conclusion
At the current market price for the RZV, preliminary findings show that it would not be a cost-effective option to adopt within a national mass vaccination programme, also considering its equity impact on population health. The price would need to considerably drop for the RZV to be cost-effective in Sweden.