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. 2025 Apr 25;25(1):604.
doi: 10.1186/s12913-025-12550-x.

Cost-effectiveness and public health impact of recombinant zoster vaccine versus no herpes zoster vaccination in selected populations of immunocompromised adults in Canada

Sydney George  1 , Justin Carrico  2 , Katherine A Hicks  2 , Dessi Loukov  3 , Cheryl Ng  4 , Desmond Curran  5
Affiliations

Cost-effectiveness and public health impact of recombinant zoster vaccine versus no herpes zoster vaccination in selected populations of immunocompromised adults in Canada

Sydney George et al. BMC Health Serv Res. .

Abstract

Background: The risk of herpes zoster (HZ) increases with age and in immunocompromised (IC) patients. Recombinant zoster vaccine (RZV) is currently recommended in Canada for people aged ≥ 50 years. The objectives of the current study were to evaluate the cost-effectiveness and public health impact of RZV versus no HZ vaccination in select Canadian IC adult populations.

Methods: The ZOster ecoNomic Analysis ImmunoCompromised (ZONA IC) model followed a base-case cohort of 1600 patients with hematopoietic stem-cell transplant (HSCT) from a starting age of 55 years, who maintained IC status for 5 years, from a societal perspective. Scenario analyses were conducted for patients with breast cancer, renal transplant, human immunodeficiency virus (HIV), and Hodgkin lymphoma. These probabilistic analyses used a life-long time horizon and discount rates of 1.5% for costs and quality-adjusted life-years (QALYs). First-dose coverage was assumed to be 60% and second-dose completion 100%. Deterministic one-way sensitivity analysis for the base case was performed. Costs are reported in 2022 Canadian dollars, with an assumed cost-effectiveness threshold of $50,000 per QALY gained.

Results: In the base-case analysis (HSCT), it was estimated that RZV would prevent medians of 116 HZ and 27 postherpetic neuralgia (PHN) cases, respectively versus no HZ vaccination. Estimated median numbers needed to vaccinate were 8 and 35 to avoid one HZ and one PHN case, respectively. The median incremental cost-effectiveness ratio (ICER) was $22,648 per QALY gained and was most sensitive to assumptions of HZ incidence, direct medical costs for unvaccinated HZ without PHN, and RZV efficacy against PHN. In other IC populations, estimated median ICERs were $24,328 (breast cancer), $27,237 (renal transplant), $67,207 (HIV), and $81,470 (Hodgkin lymphoma).

Conclusions: RZV in Canada improves public health outcomes and is likely cost-effective for several IC conditions.

Keywords: Breast cancer; Canada; Hematopoietic stem-cell transplant; Hodgkin lymphoma; Human immunodeficiency virus; Immunocompromised; Recombinant zoster vaccine; Renal transplant.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: DL, IK, CN, and DC are employed by, and holds financial equities in GSK. SG is employed by GSK. JC and KH are employed by RTI - Health Solutions and their employer received consulting fees from GSK to perform the work contributing to this research. All authors declare no other financial and non-financial relationships and activities.

Figures

Fig. 1
Fig. 1
Underlying structure of the ZONA IC model. aModified from Curran et al. [24]. aVaccination may or may not occur in the “No HZ” health state, depending on the modeled strategy. Blue boxes indicate overall health states; dark and light orange boxes indicate initial and recurrent HZ states, respectively; green boxes indicate no HZ states. HZ, herpes zoster; IC, immunocompromised; PHN, postherpetic neuralgia; ZONA IC ZOster ecoNomic Analysis ImmunoCompromised
Fig. 2
Fig. 2
CEAC from 5000 simulations for RZV versus no HZ vaccine for Canadian HSCT adults. All costs are in 2022 Canadian dollars. CEAC, cost-effectiveness acceptability curve; HSCT, hematopoietic stem-cell transplant; HZ, herpes zoster; QALY, quality-adjusted life-year; RZV, recombinant zoster vaccine
Fig. 3
Fig. 3
DSA results for the ICERs of RZV versus no HZ vaccine for Canadian HSCT adultsa. All costs are in 2022 Canadian dollars. aOnly the top 10 results are shown. DSA, deterministic sensitivity analysis; HSCT, hematopoietic stem-cell transplant; HZ, herpes zoster; ICER, incremental cost-effectiveness ratio; PHN, postherpetic neuralgia; QALY, quality-adjusted life-year; RZV, recombinant zoster vaccine; YOA, years of age
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