Cost-effectiveness of the recombinant zoster vaccine (RZV) against herpes zoster: An updated critical review

The objective of this study was to critically review the cost-effectiveness (CE) of the recombinant zoster vaccine (RZV) against herpes zoster (HZ). A literature review was conducted in PubMed, Embase, and Cochrane between January 1, 2017, and February 28, 2022, and on select public healthcare agency websites to identify and collect data from CE studies comparing RZV to zoster vaccine live (ZVL) or to no vaccination. Study characteristics, inputs, and outputs were collected. The overall CE of RZV was assessed. RZV vaccination against HZ is cost-effective in 15 out of 18 studies included in the present review. Varying incremental cost-effectiveness ratios (ICERs) observed may be associated with different assumptions on the duration of protection of RZV, as well as different combinations of structural and disease-related study (model) inputs driving the estimation of ICERs. Plain Language SummaryWhat is the context?center dot Herpes zoster, also known as shingles, may cause painful rashes and skin alterations.center dot Chronic pain, also referred to as post-herpetic neuralgia, may persist for months or even years after the initial rash.center dot The disease is caused by reactivation of the varicella zoster virus.center dot The recombinant zoster vaccine (RZV) and the zoster vaccine live (ZVL) are approved for the prevention of herpes zoster and post-herpetic neuralgia.center dot We reviewed published evidence from the past 5 years on RZV.What is new?center dot Out of 18 selected studies, RZV vaccination against herpes zoster and post-herpetic neuralgia is cost-effective in 15.center dot In the 15 studies establishing RZV cost-effectiveness, RZV is always cost-effective or frequently cost-saving in direct comparisons to ZVL, when applicable.center dot RZV was found cost-saving in several immune-compromised populations.What is the impact?center dot The overview of the currently available body of evidence related to cost-effectiveness of RZV may help informing decision makers about the value of vaccination against herpes zoster.