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dc.contributor.authorde Boer, Pieter T
dc.contributor.authorvan Lier, Alies
dc.contributor.authorde Melker, Hester
dc.contributor.authorvan Wijck, Albert J M
dc.contributor.authorWilschut, Jan C
dc.contributor.authorvan Hoek, Albert Jan
dc.contributor.authorPostma, Maarten J
dc.date.accessioned2019-02-26T12:22:05Z
dc.date.available2019-02-26T12:22:05Z
dc.date.issued2018-12-06
dc.identifier.issn1741-7015
dc.identifier.pmid30518427
dc.identifier.doi10.1186/s12916-018-1213-5
dc.identifier.urihttp://hdl.handle.net/10029/622844
dc.description.abstractThe newly registered adjuvanted herpes zoster subunit vaccine (HZ/su) has a higher efficacy than the available live-attenuated vaccine (ZVL). National decision-makers soon need to decide whether to introduce HZ/su or to prefer HZ/su above ZVL. Using a Markov model with a decision tree, we conducted a cost-effectiveness analysis of vaccination with HZ/su (two doses within 2 months) or zoster vaccine live (ZVL) (single dose, or single dose with a booster after 10 years) for cohorts of 50-, 60-, 70- or 80-year-olds in the Netherlands. The model was parameterized using vaccine efficacy data from randomized clinical trials and up-to-date incidence, costs and health-related quality of life data from national datasets. We used a time horizon of 15 years, and the analysis was conducted from the societal perspective. At a coverage of 50%, vaccination with two doses of HZ/su was estimated to prevent 4335 to 10,896 HZ cases, depending on the cohort age. In comparison, this reduction was estimated at 400-4877 for ZVL and 427-6466 for ZVL with a booster. The maximum vaccine cost per series of HZ/su to remain cost-effective to a willingness-to-pay threshold of €20,000 per quality-adjusted life year (QALY) gained ranged from €109.09 for 70-year-olds to €63.68 for 50-year-olds. The cost-effectiveness of ZVL changed considerably by age, with corresponding maximum vaccine cost per dose ranging from €51.37 for 60-year-olds to €0.73 for 80-year-olds. Adding a ZVL booster after 10 years would require a substantial reduction of the maximum cost per dose to remain cost-effective as compared to ZVL single dose. Sensitivity analyses on the vaccine cost demonstrated that there were scenarios in which vaccination with either HZ/su (two doses), ZVL single dose or ZVL + booster could be the most cost-effective strategy. A strategy with two doses of HZ/su was superior in reducing the burden of HZ as compared to a single dose or single dose + booster of ZVL. Both vaccines could potentially be cost-effective to a conventional Dutch willingness-to-pay threshold for preventive interventions. However, whether HZ/su or ZVL would be the most cost-effective alternative depends largely on the vaccine cost.en_US
dc.language.isoenen_US
dc.subjectCost-effectivenessen_US
dc.subjectHerpes zosteren_US
dc.subjectLive-attenuated vaccineen_US
dc.subjectPost-herpetic neuralgiaen_US
dc.subjectSubunit vaccineen_US
dc.subjectVaccinationen_US
dc.titleCost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines.en_US
dc.typeArticleen_US
dc.identifier.journalBMC Med 2018; 16(1):228en_US
dc.source.journaltitleBMC medicine


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