OBJECTIVES: Herpes Zoster (HZ) is a unilateral painful rash caused by the reactivation of Varicella virus following a decline in the immune system related to ageing, immunosuppressive treatment or immunocompromising diseases. HZ and its complications (including Post-Herpetic Neuralgia (PHN)) are preventable by HZ vaccination. We investigated the cost-effectiveness and public health impact of Recombinant Zoster Vaccine (RZV) among adults aged ≥50 years in Austria.

METHODS: Using a static multi-cohort Markov model, a hypothetical cohort received RZV and was compared to a non-vaccinated cohort over a lifetime horizon. Scenarios with different RZV coverage were considered. Using the societal perspective and applying a 3% discount rate, we evaluated the quality-adjusted life years (QALY), vaccinations costs, direct medical and indirect costs (in 2022 euros). We estimated the incremental cost-effectiveness ratio (ICER) and compared it to a hypothetical willingness-to-pay threshold of €49,369/QALY (one Austrian Gross Domestic Product (GDP) per capita). German and Austrian data were used, and a deterministic one way and probabilistic sensitivity analyses were performed.

RESULTS: One million adults aged ≥50 years were vaccinated with RZV using 1st and 2nd dose coverage of 30% and 90%, respectively. RZV averted 50,235 HZ cases, 9,092 PHN cases and €50 million in direct and indirect costs over a lifetime, gaining 1,663 QALYs with an ICER of €25,258/QALY. The public health impact of vaccinating all Austrians aged ≥50 years with RZV was evaluated in a scenario analysis (approximately 3.7 million people, 1st and 2nd dose coverage=100%), leading to 670,546 HZ cases and 121,682 PHN cases prevented. Assuming a one GDP/capita threshold, RZV is cost-effective, and the results remained robust in sensitivity analyses.

CONCLUSIONS: Vaccinating with RZV would reduce the burden of HZ and PHN, prevent the related loss of quality of life and be cost-effective in Austria.