Modelling the Public Health Burden of Herpes Zoster and the Impact of Adjuvanted Recombinant Zoster Vaccine in Five Selected Countries in Southeast Asia

Abstract

Introduction: Herpes zoster (HZ) can cause substantial patient morbidity and lead to large healthcare costs. However, the disease burden of HZ in Southeast Asia may be underestimated. This study aimed to estimate the public health burden of HZ and the impact of vaccinating adults aged ≥ 50 years old in five Southeast Asian countries (Indonesia, Malaysia, Philippines, Thailand, and Vietnam), with adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination.

Methods: For each country, we adapted a static multicohort Markov model developed with a 1-year cycle length and lifetime horizon. Demographics were obtained from the World Health Organization, HZ incidence from a worldwide meta-regression reporting Asian-specific values, proportions of postherpetic neuralgia (PHN) and non-PHN complications from local/regional studies, and vaccine efficacy from a long-term follow-up trial. First-dose coverage and second-dose compliance were assumed to be 30% and 70%, respectively. A one-way deterministic sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness and uncertainty of inputs for each country.

Results: Without RZV, it was estimated that there would be a total of approximately 10 million HZ cases, 2.1 million PHN cases, and 1.4 million non-PHN complications in individuals aged ≥ 50 years included in the model. Introducing RZV under 30% coverage could avoid approximately 2.2 million (22%) HZ cases, almost 500,000 (21%) PHN cases, and around 300,000 (22%) non-PHN complications. OWSA showed that first-dose coverage and initial HZ incidence had the largest impact on the estimated number of HZ cases avoided. The number needed to vaccinate ranged from 15 to 21 to prevent one case of HZ and from 68 to 104 to prevent one case of PHN across each country.

Conclusions: This study demonstrated that there is substantial HZ disease burden in older adults for the five selected countries in Southeast Asia, negatively impacting national healthcare systems. Introducing RZV could potentially reduce this burden. A graphical abstract is available with this article.

Keywords: HZ; Herpes zoster; PHN; Postherpetic neuralgia; Public health impact; RZV; Recombinant zoster vaccine; Southeast Asia.

Fig. 1

Projected cases of HZ avoided with RZV per country. HZ herpes zoster, PHN postherpetic neuralgia, RZV recombinant zoster vaccine

Fig. 2

Number of individuals needed to vaccinate with RZV to prevent one case of HZ. a Stratified by country. b Stratified by country and age. HZ herpes zoster, RZV recombinant zoster vaccine, yrs years

Fig. 3

Number of individuals needed to vaccinate with RZV to prevent one case of PHN. a Stratified by country. b Stratified by age and country. PHN postherpetic neuralgia, RZV recombinant zoster vaccine, yrs years

Fig. 4

Results of the one-way deterministic sensitivity analysis per country. a Indonesia, b Malaysia, c Philippines, d Thailand, e Vietnam. HZ herpes zoster, NNV number of individuals needed to vaccinate, PHN postherpetic neuralgia, RZV recombinant zoster vaccine, YOA years of age

Fig. 5

Results of the probabilistic sensitivity analysis per country. a Indonesia, b Malaysia, c Philippines, d Thailand, e Vietnam. HZ herpes zoster

Fig. 6

Findings from scenario analyses. ^aThis scenario compared the worst case of 20% first-dose coverage rate and 45% of second-dose compliance rate and the best case of 80% of first-dose coverage rate and 95% of second-dose compliance rates. HZ herpes zoster