OBJECTIVES:

Herpes zoster (HZ) represents an economic and humanistic burden for healthcare systems. The incidence of HZ and its complications —such as postherpetic neuralgia (PHN)— increase with age. In Switzerland, two HZ vaccines are available: the adjuvanted recombinant zoster vaccine (RZV) and the zoster live vaccine. RZV is approved for adults aged ≥50 years and immunocompromised adults. We assessed the cost-effectiveness of vaccinating adults aged ≥65 years with RZV versus no vaccination, in Switzerland.

METHODS:

We used a multi-cohort Markov model to compare two hypothetical cohorts of 1,000,000 adults aged ≥65 years over a lifetime horizon, from the healthcare payer perspective. One cohort was not vaccinated, the other received RZV with a 30% coverage for the first dose and a 75% compliance for the second dose. Outcomes evaluated were quality-adjusted life-years (QALYs) and costs, including vaccination costs and direct medical costs related to HZ management. Health outcomes were discounted at 1.5% and costs at 3.5%. The incremental cost-effectiveness ratio (ICER) was compared to a hypothetical willingness-to-pay threshold of CHF 54,500. Deterministic and probabilistic sensitivity analyses were conducted.

RESULTS:

Vaccination with RZV would avoid 38,978 HZ cases, 7,758 PHN cases and 4,775 other complication cases. RZV vaccination would yield 1,685 QALYs and prevent CHF 49 million in direct medical costs. The ICER was estimated at CHF 39,656 per QALY gained. The number needed to vaccinate (NNV) to prevent a HZ and a PHN case was 8 and 39, respectively. The RZV vaccination strategy has an 85% probability of being cost-effective. Vaccinating only adults aged 65–69 years would yield an ICER of CHF 30,822 per QALY gained.

CONCLUSIONS:

Vaccinating with RZV would be cost-effective and considerably reduce the disease burden. This demonstrates the importance of implementing RZV vaccination in older adults in Switzerland.