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Is herpes zoster vaccination likely to be cost-effective in Canada?

  • Systematic Review
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Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

OBJECTIVES: To synthesize the current literature detailing the cost-effectiveness of the herpes zoster (HZ) vaccine, and to provide Canadian policymakers with cost-effectiveness measurements in a Canadian context.

METHODS: This article builds on an existing systematic review of the HZ vaccine that offers a quality assessment of 11 recent articles. We first replicated this study, and then two assessors reviewed the articles and extracted information on vaccine effectiveness, cost of HZ, other modelling assumptions and QALY estimates. Then we transformed the results into a format useful for Canadian policy decisions. Results expressed in different currencies from different years were converted into 2012 Canadian dollars using Bank of Canada exchange rates and a Consumer Price Index deflator. Modelling assumptions that varied between studies were synthesized. We tabled the results for comparability.

SYNTHESIS: The Szucs systematic review presented a thorough methodological assessment of the relevant literature. However, the various studies presented results in a variety of currencies, and based their analyses on disparate methodological assumptions. Most of the current literature uses Markov chain models to estimate HZ prevalence. Cost assumptions, discount rate assumptions, assumptions about vaccine efficacy and waning and epidemiological assumptions drove variation in the outcomes. This article transforms the results into a table easily understood by policy-makers.

CONCLUSION: The majority of the current literature shows that HZ vaccination is cost-effective at the price of $100,000 per QALY. Few studies showed that vaccination cost-effectiveness was higher than this threshold, and only under conservative assumptions. Cost-effectiveness was sensitive to vaccine price and discount rate.

Résumé

OBJECTIFS: Faire une synthèse de la littérature actuelle sur le rapport coût-efficacité du vaccin contre le virus de l’herpès zoster (zona) et fournir aux responsables des politiques du Canada des indicateurs coûtefficacité dans un contexte canadien.

MÉTHODE : Cet article fait fond sur une revue systématique existante qui évalue la qualité de 11 articles récents portant sur le vaccin contre le zona. Nous avons d’abord reproduit l’étude, après quoi deux évaluateurs ont examiné les articles et en ont extrait l’information sur l’efficacité du vaccin, le coût du zona, les autres postulats de modélisation et les estimations des années de vie pondérées par la qualité (AVPQ). Ensuite, nous avons transposé les résultats sous une forme utile aux décisions stratégiques canadiennes. Les résultats, exprimés en différentes devises pour différentes années, ont été convertis en dollars canadiens de 2012 à l’aide des taux de change de la Banque du Canada et d’un déflateur: l’indice des prix à la consommation. Les postulats de modélisation variables d’une étude à l’autre ont été synthétisés. Nous avons mis les résultats en tableaux pour pouvoir les comparer.

SYNTHÈSE : La revue systématique de Szucs présentait une évaluation méthodologique exhaustive de la littérature pertinente. Cependant, les résultats des diverses études étaient présentés dans toutes sortes de devises, et les analyses étaient fondées sur des postulats méthodologiques disparates. La plupart des articles récents font appel aux modèles en chaînes de Markov pour estimer la prévalence du zona. Les postulats relatifs aux coûts, aux taux d’actualisation, à l’efficacité potentielle du vaccin, à la baisse de l’immunité conférée par le vaccin, ainsi que les postulats épidémiologiques, ont fait varier les résultats. Notre article transpose ces résultats dans un tableau facile à comprendre pour les responsables des politiques.

CONCLUSION : Selon la majorité des articles récents, la vaccination contre le zona est rentable au prix de 100 000 $ par AVPQ. Peu d’études indiquent un rapport coût-efficacité de la vaccination supérieur à ce seuil, et seulement sur la base de postulats prudents. Le rapport coût-efficacité était sensible au prix et au taux d’actualisation du vaccin.

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Authors and Affiliations

  1. Dept. of Community Health Sciences, Faculty of Medicine, University of Manitoba, 260 Brodie Centre, 727 McDermot Avenue, Winnipeg, MB, R3E 0W3, Canada

    Alexander D. Peden MA, Stephenson B. Strobel MA & Evelyn L. Forget PhD

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  1. Alexander D. Peden MA
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  2. Stephenson B. Strobel MA
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  3. Evelyn L. Forget PhD
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Correspondence to Alexander D. Peden MA.

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Acknowledgement of Sources of Funding: International Centre for Infectious Diseases and Public Health Agency of Canada.

Conflict of Interest: None to declare.

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Peden, A.D., Strobel, S.B. & Forget, E.L. Is herpes zoster vaccination likely to be cost-effective in Canada?. Can J Public Health 105, e287–e295 (2014). https://doi.org/10.17269/cjph.105.4299

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  • DOI: https://doi.org/10.17269/cjph.105.4299

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