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. 2015;11(4):884-96.
doi: 10.1080/21645515.2015.1011561.

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Emmanuelle Préaud  1 , Mathieu Uhart, Katharina Böhm, Pamela Aidelsburger, Delphine Anger, Florence Bianic, Nathalie Largeron
Affiliations

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany

Emmanuelle Préaud et al. Hum Vaccin Immunother. 2015.

Abstract

Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.

Keywords: ASHIP, Association of Statutory Health Insurance Physicians; CEAC, Cost-effectiveness acceptability curves; CMI, Cell-mediated immunity; DSA, Deterministic sensitivity analysis; EBM, German uniform assessment standard (Einheitlicher Bewertungsmaßstab); EMA, European Medicines Agency; EQ-5D, EuroQoL; G-DRG, German Diagnosis Related Groups; GePaRD German Pharmacoepidemiological Research Database; Germany; HZ, Herpes zoster; ICER, Incremental cost-effectiveness ratio; IQWIG, German Institute for Quality and Efficiency in Health Care; NNV, Number needed to vaccinate; PHN, Post-herpetic neuralgia; PSA, Probabilistic sensitivity analysis; QALY, Quality-adjusted life year; SHI, Statutory health insurance; SPS, Shingles Prevention Study; STIKO, German Standing Committee on Immunisation; STPS, Short-Term Persistence Substudy; US, United States; VZV, Varizella zoster virus; YO, Years old; ZEST, Zostavax® Efficacy and Safety Trial; cost-effectiveness; herpes zoster; mBPI-SF Modified short form brief pain inventory; markov model; post-herpetic neuralgia; vaccination; zostavax.

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Figures

Figure 6.
Figure 6.
Basic decision tree Markov Model.
Figure 7.
Figure 7.
Markov model structure HZ = herpes zoster; PHN = post-herpetic neuralgia.
Figure 8.
Figure 8.
Evolution of vaccine efficacy over time DSA = Deterministic sensitivity analysis; yo = years old.
Figure 1.
Figure 1.
Sensitivity analysis overview: SHI perspective for 60+ population DSA = deterministic sensitivity analyses; HZ = herpes zoster; ICER = incremental cost-effectiveness ratio; PHN = post-herpetic neuralgia; SHI = statutory health insurance.
Figure 2.
Figure 2.
Sensitivity analysis overview: SHI perspective for 50+ population DSA = deterministic sensitivity analyses; HZ = herpes zoster; ICER = incremental cost-effectiveness ratio; PHN = post-herpetic neuralgia; SHI = statutory health insurance.
Figure 3.
Figure 3.
Sensitivity analysis overview: societal perspective for 60+ population DSA = deterministic sensitivity analyses; HZ = herpes zoster; ICER = incremental cost-effectiveness ratio; PHN = post-herpetic neuralgia.
Figure 4.
Figure 4.
Sensitivity analysis overview: societal perspective for 50+ population DSA = deterministic sensitivity analyses; HZ = herpes zoster; ICER = incremental cost-effectiveness ratio; PHN = post-herpetic neuralgia.
Figure 5.
Figure 5.
Cost-effectiveness acceptability curves ICER = incremental cost-effectiveness ratio; SHI = statutory health insurance.
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