In the JournalsPerspective

Recombinant zoster vaccine offers better value, protection against shingles

Vaccination with the recombinant zoster vaccine demonstrated higher cost-effectiveness and prevention of herpes zoster, compared with live zoster vaccine and no vaccination, according to research published in Annals of Internal Medicine.

“A new herpes zoster subunit vaccine, recombinant zoster vaccine (RZV), was approved by the FDA and recommended by the ACIP in October 2017,” Lisa A. Prosser, PhD, director of the Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School, and colleagues wrote. “This newer vaccine has shown higher efficacy than zoster vaccine live (ZVL) in clinical trials. Uptake of ZVL has been low, and only 33% of adults aged 60 years or older reported receipt of ZVL by 2016.”

Prosser and colleagues developed a simulation model using epidemiologic, clinical and cost data from the United States to determine the cost-effectiveness of RZV compared with ZVL and no vaccination. The researchers also evaluated how cost-effective vaccination with RZV was for individuals who previously received the ZVL and whether the RZV should be recommended over ZVL because of cost.

They created a hypothetical cohort of immunocompetent adults aged 50 years and older.

For all age groups, the RZV prevented herpes zoster more often than ZVL. Over the lifetime horizon, 30% of cases were prevented with the RZV for persons aged 50 to 59 years and 72% of cases for those aged 80 to 89 years, compared with no vaccination.

Total costs were lower with RZV vaccination compared with ZVL vaccination for all age groups. Vaccination with RZV or ZVL cost more than no vaccination.

When using a societal perspective and assuming that the two-dose RZV regimen was completed, the researchers found that the incremental cost-effectiveness ratios (ICERs) for vaccination with RZV vs. no vaccination ranged from $10,000 to $47,000 per quality-adjusted life-year depending on age.

For vaccination with RZV after previous administration of ZVL among individuals aged 60 years or older, ICERs were less than $60,000 per QALY, according to the researchers.

Vaccination with RZV vaccination was more cost-effective and had more health benefits than ZVL across all age groups.

RZV was the preferred vaccination method in 84% of simulations for individuals aged 50 to 59 years, 95% of simulations for those aged 60 to 69 years and more than 99% of simulations for those aged 70 to 99 years, according to the researchers.

In an accompanying editorial, Stephen D. Shafran, MD, professor in the division of infectious disease at the University of Alberta, Canada, wrote that ongoing surveillance of the duration of protection with RZV against herpes zoster is needed since it is still newly approved.

“Nevertheless, the best available data, including the analysis by Prosser and colleagues, support the ACIP recommendations for preferential use of RZV over ZVL starting at age 50 years and for administering RZV to those who previously received ZVL,” he wrote. – by Alaina Tedesco

 

Disclosures: Prosser reports receiving research funding from the CDC. Shafran reports receiving grants from AbbVie, BMS and Janssen; grants and personal fees from Gilead and Merck; and personal fees from Pfizer. All other authors reported no relevant financial disclosures.

Vaccination with the recombinant zoster vaccine demonstrated higher cost-effectiveness and prevention of herpes zoster, compared with live zoster vaccine and no vaccination, according to research published in Annals of Internal Medicine.

“A new herpes zoster subunit vaccine, recombinant zoster vaccine (RZV), was approved by the FDA and recommended by the ACIP in October 2017,” Lisa A. Prosser, PhD, director of the Susan B. Meister Child Health Evaluation and Research Center at University of Michigan Medical School, and colleagues wrote. “This newer vaccine has shown higher efficacy than zoster vaccine live (ZVL) in clinical trials. Uptake of ZVL has been low, and only 33% of adults aged 60 years or older reported receipt of ZVL by 2016.”

Prosser and colleagues developed a simulation model using epidemiologic, clinical and cost data from the United States to determine the cost-effectiveness of RZV compared with ZVL and no vaccination. The researchers also evaluated how cost-effective vaccination with RZV was for individuals who previously received the ZVL and whether the RZV should be recommended over ZVL because of cost.

They created a hypothetical cohort of immunocompetent adults aged 50 years and older.

For all age groups, the RZV prevented herpes zoster more often than ZVL. Over the lifetime horizon, 30% of cases were prevented with the RZV for persons aged 50 to 59 years and 72% of cases for those aged 80 to 89 years, compared with no vaccination.

Total costs were lower with RZV vaccination compared with ZVL vaccination for all age groups. Vaccination with RZV or ZVL cost more than no vaccination.

When using a societal perspective and assuming that the two-dose RZV regimen was completed, the researchers found that the incremental cost-effectiveness ratios (ICERs) for vaccination with RZV vs. no vaccination ranged from $10,000 to $47,000 per quality-adjusted life-year depending on age.

For vaccination with RZV after previous administration of ZVL among individuals aged 60 years or older, ICERs were less than $60,000 per QALY, according to the researchers.

Vaccination with RZV vaccination was more cost-effective and had more health benefits than ZVL across all age groups.

RZV was the preferred vaccination method in 84% of simulations for individuals aged 50 to 59 years, 95% of simulations for those aged 60 to 69 years and more than 99% of simulations for those aged 70 to 99 years, according to the researchers.

In an accompanying editorial, Stephen D. Shafran, MD, professor in the division of infectious disease at the University of Alberta, Canada, wrote that ongoing surveillance of the duration of protection with RZV against herpes zoster is needed since it is still newly approved.

“Nevertheless, the best available data, including the analysis by Prosser and colleagues, support the ACIP recommendations for preferential use of RZV over ZVL starting at age 50 years and for administering RZV to those who previously received ZVL,” he wrote. – by Alaina Tedesco

 

Disclosures: Prosser reports receiving research funding from the CDC. Shafran reports receiving grants from AbbVie, BMS and Janssen; grants and personal fees from Gilead and Merck; and personal fees from Pfizer. All other authors reported no relevant financial disclosures.

    Perspective
    William Schaffner

    William Schaffner

    Herpes zoster causes an estimated 1 million illness episodes per year in the United States. The risk of both the disease and its complications increase with advancing age. Although rarely fatal, herpes zoster is responsible for substantial disability. Its acute phase lasts 2 to 3 weeks and, if the rash involves the face, vision can be threatened. The prominent complication of post-herpetic neuralgia (PHN) can persist for months to years. This episodic lancinating pain is difficult to treat and often curtails patients from engaging in normal social activities.

    Fortunately, herpes zoster can be prevented. A new two-dose recombinant vaccine (Shingrix, GlaxoSmithKline) has been shown to be approximately 90% effective. This high degree of protection also extends to persons 70 years of age and older. The inoculations often produce notable local pain and soreness, but that is a small annoyance to avoid shingles and PHN.

    Who should receive this vaccine? The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that it be given to all immunocompetent persons who are 50 years of age or older (recommendations for immunocompromised patients are forthcoming). Shingrix is preferred over the earlier live-attenuated vaccine (Zostavax, Merck) because it is more effective and because protection is anticipated to be longer-lasting. All patients who previously had received Zostavax now should also receive Shingrix.

    The current study affirms that this vaccination strategy is cost-effective. Indeed, the vaccine already has become so accepted by both providers and patients that the manufacturer is stretched to provide a sufficient supply and spot shortages are occurring. The physicians at our medical center are collaborating with local pharmacies in order to get the vaccine to as many of our eligible patients as quickly as possible.

    • William Schaffner, MD
    • Professor of Preventive Medicine, Department of Health Policy
      Professor of Medicine, Division of Infectious Diseases
      Vanderbilt University School of Medicine

    Disclosures: Schaffner reports no relevant financial disclosures.