OBJECTIVES: Varicella-zoster virus (VZV) causes chickenpox in children, and subsequently establishes a latent infection in dorsal root ganglia in the spinal cord. Decades later, it may reactivate, causing herpes zoster (HZ), a painful dermatomal skin rash (“shingles”), in adults and especially in older individuals. Reactivation of latent VZV is mostly due to immunosenescence, i.e., an age-related functional decline of the immune system. A potential complication linked to HZ is postherpetic neuralgia (PHN), characterised by neuropathic pain which can last for months or years. The Recombinant Zoster Vaccine (RZV) is currently being considered for inclusion in a national immunisation programme (NIP) for older adults in the Netherlands. The aim of the current study was to assess the public health impact and cost-effectiveness of RZV vaccination considering the latest evidence regarding vaccine efficacy.

METHODS: The ZOster ecoNomic Analysis (ZONA) model was used to assess the Incremental Cost-Effectiveness Ratio (ICER) of RZV vaccination for all Dutch 60-year-olds, compared to not introducing the vaccine. Costs and health outcomes were assessed from a societal perspective over a lifetime horizon, using the latest 8-year vaccine efficacy data.

RESULTS: Introducing RZV vaccination into a NIP for 60-year-olds in the Netherlands would prevent around 21,083 cases of HZ and over 1,539 cases of PHN over the patients’ lifetime, avoiding over 88,128 General Practitioner (GP) consultations and 493 hospital admissions. In the base case, the ICER of RZV vaccination was estimated at €36,651 per Quality-Adjusted Life Year (QALY) gained.

CONCLUSIONS: Adding RZV for 60-year-olds has the potential to significantly reduce the burden of HZ in the Netherlands. Cost-effectiveness will become more favourable based on a lower RZV price than the list price investigated in the present study, which is common and feasible in the context of a NIP.