Vaccination is safe and effective, but is it cost-effective?
A live
attenuated varicella zoster virus (VZV) vaccine decreases the
incidence and severity of herpes zoster and postherpetic neuralgia (PHN)
when it is given to older adults (age,
60; Journal
Watch Jun 14 2005), but insurers will wonder whether it is
worthwhile. Using a decision analytic model, California researchers
studied the cost-effectiveness of VZV vaccination (vs. no
vaccination) of older immunocompetent adults with histories of VZV
infection. The model included incidence of zoster, incidence and
duration of PHN, local vaccine reactions, health-state utilities, and
costs of healthcare, vaccine, and lost productivity.
When calculated with a vaccination cost of US$100 (which included both vaccine and related costs), cost per quality-adjusted life-year (QALY) gained was $50,000 (assuming at least 20-year efficacy). At a vaccination cost of $200, the cost per QALY gained was always more than $100,000. Vaccination was more cost-effective in people who were 60 to 64 than in those who were 65 or older and was more cost-effective when zoster-associated quality of life was assumed to be worse.
Comment: If cost were not an issue in our health system, administering this relatively safe vaccine to all elders to prevent zoster and postherpetic neuralgia would make sense. Editorialists report the price of VZV vaccine at $150 per dose; they imply that, given the uncertainties around some of the model estimates, this cost-effectiveness analysis should not be the last word on the matter. For now, some insurance companies offer varying degrees of coverage for zoster vaccination.
— Richard Saitz, MD, MPH, FACP, FASAM
Published in Journal Watch October 5, 2006
Citation(s):
Hornberger J and Robertus K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006 Sep 5; 145:317-25.