HEALTH AND ECONOMIC EFFECTS OF RECOMBINANT ZOSTER VACCINATION AMONG UNINSURED ADULTS IN THE UNITED STATES USING ALTERNATIVE VALUATION METHODS
Author(s)
Fangjun Zhou, PhD, Tursynbek Nurmagambetov, MS, PhD, RajReni Kaul, MS, PhD, Tara C. Jatlaoui, MD, MPH;
Centers for Disease Control and Prevention, NCIRD, Atlanta, GA, USA
Centers for Disease Control and Prevention, NCIRD, Atlanta, GA, USA
OBJECTIVES: Herpes zoster (HZ) and its complication, postherpetic neuralgia (PHN), impose substantial health and economic burden on older adults in the United States (U.S.). Although the recombinant zoster vaccine (RZV) has high clinical efficacy and favorable economic performance, vaccination coverage remains low, especially among uninsured adults. This study aims to evaluate the health and economic impact of providing cost-free RZV vaccination to uninsured U.S. adults aged ≥ 50 years using multiple valuation frameworks.
METHODS: We developed a decision-tree-based Markov transition model, incorporating disease incidence, vaccination coverage, adverse event rates, and cost estimates associated with disease management, complications, and vaccine administration. The model estimated lifetime health and economic outcomes of a cost-free two-dose RZV vaccination strategy among approximately 5.5 million uninsured adults aged ≥50 years in the U.S. A 5-percentage point absolute increase in two-dose RZV coverage was assumed. Analyses were conducted from a societal perspective with costs and benefits discounted at 3% annually. Outcomes included HZ and PHN cases averted, quality-adjusted life years (QALYs) gained, net present values, and benefit-cost ratios (BCRs). Benefits were valued using three approaches: Human Capital, GDP-based valuation of QALYs, and Value per Statistical Life (VSL). Extensive univariate sensitivity analyses were performed.
RESULTS: RZV vaccination would averts 42,500 HZ cases, 6,023 PHN cases, and 81 deaths, generating 2,219 QALYs gained. Total public investment required was approximately $106 million. Base-case BCRs of RZV vaccination ranged from 1.2 to 6.2 across valuation approaches, indicating net societal savings, with the VSL-based approach yielding the highest BCR of 6.2. Results were most sensitive to assumptions regarding HZ incidence, PHN risk, and waning of vaccine effectiveness.
CONCLUSIONS: The findings of our analysis strongly support offering cost-free RZV vaccination to uninsured adults. This program would significantly reduce the burden of herpes zoster, enhance quality of life, and yield substantial societal economic benefits.
METHODS: We developed a decision-tree-based Markov transition model, incorporating disease incidence, vaccination coverage, adverse event rates, and cost estimates associated with disease management, complications, and vaccine administration. The model estimated lifetime health and economic outcomes of a cost-free two-dose RZV vaccination strategy among approximately 5.5 million uninsured adults aged ≥50 years in the U.S. A 5-percentage point absolute increase in two-dose RZV coverage was assumed. Analyses were conducted from a societal perspective with costs and benefits discounted at 3% annually. Outcomes included HZ and PHN cases averted, quality-adjusted life years (QALYs) gained, net present values, and benefit-cost ratios (BCRs). Benefits were valued using three approaches: Human Capital, GDP-based valuation of QALYs, and Value per Statistical Life (VSL). Extensive univariate sensitivity analyses were performed.
RESULTS: RZV vaccination would averts 42,500 HZ cases, 6,023 PHN cases, and 81 deaths, generating 2,219 QALYs gained. Total public investment required was approximately $106 million. Base-case BCRs of RZV vaccination ranged from 1.2 to 6.2 across valuation approaches, indicating net societal savings, with the VSL-based approach yielding the highest BCR of 6.2. Results were most sensitive to assumptions regarding HZ incidence, PHN risk, and waning of vaccine effectiveness.
CONCLUSIONS: The findings of our analysis strongly support offering cost-free RZV vaccination to uninsured adults. This program would significantly reduce the burden of herpes zoster, enhance quality of life, and yield substantial societal economic benefits.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE407
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, STA: Vaccines