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Background and objectives <p>Herpes zoster (HZ) and associated complications comprise a considerable public health burden in older adults. This study aimed to evaluate the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in older adults in Portugal.</p> Methods <p>A static multicohort Markov model (ZONA) was adapted to the Portuguese context. The base-case compared RZV with no vaccination in a hypothetical cohort of 1 million adults aged ≥65&#xa0;years. Real-world data were used for first-dose coverage (56.1%) and second-dose completion (67.2%), with vaccine efficacy and waning based on 11-year follow-up data. Outcomes were calculated over a lifetime horizon from the societal perspective, with a 4% discount applied to costs and quality-adjusted life years (QALYs). In the base-case, HZ incidence was based on previously reported European data. Sensitivity analyses were performed, and a scenario analysis explored the impact of alternative HZ incidence rates based on recent Portuguese data.</p> Results <p>Over a lifetime horizon, RZV was estimated to prevent 45,551 HZ cases, 9056 post-herpetic neuralgia (PHN) cases, 5580 cases with other non-PHN complications, and 6 HZ deaths. The incremental cost-effectiveness ratio (ICER) from the societal perspective was €48,707 per QALY gained, below a hypothetical willingness-to-pay threshold of two times the gross domestic product per capita per QALY gained (equivalent to €62,200). This base-case ICER was most sensitive to the annual incidence of initial HZ. In the scenario analysis, exploring higher HZ incidence based on Portuguese data, the estimated ICER was €41,877 per QALY gained. In both the base-case and the scenario analyses, ICERs were lowest in individuals aged 65–69 years, with ICERs ranging from €36,207 to €42,700 per QALY gained, in the scenario analysis and base case, respectively.</p> Conclusions <p>RZV presents a cost-effective option for the prevention of HZ and its complications in Portuguese adults aged ≥&#xa0;65 years, with greater cost effectiveness in those aged 65–69&#xa0;years.</p>

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Cost Effectiveness of the Adjuvanted Recombinant Zoster Vaccine in Older Adults in Portugal

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月2日

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  • Eleftherios Zarkadoulas,
  • Fábio Silva,
  • Joana Alves,
  • Francisco Madeira,
  • Maarten J Postma

摘要

Background and objectives

Herpes zoster (HZ) and associated complications comprise a considerable public health burden in older adults. This study aimed to evaluate the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in older adults in Portugal.

Methods

A static multicohort Markov model (ZONA) was adapted to the Portuguese context. The base-case compared RZV with no vaccination in a hypothetical cohort of 1 million adults aged ≥65 years. Real-world data were used for first-dose coverage (56.1%) and second-dose completion (67.2%), with vaccine efficacy and waning based on 11-year follow-up data. Outcomes were calculated over a lifetime horizon from the societal perspective, with a 4% discount applied to costs and quality-adjusted life years (QALYs). In the base-case, HZ incidence was based on previously reported European data. Sensitivity analyses were performed, and a scenario analysis explored the impact of alternative HZ incidence rates based on recent Portuguese data.

Results

Over a lifetime horizon, RZV was estimated to prevent 45,551 HZ cases, 9056 post-herpetic neuralgia (PHN) cases, 5580 cases with other non-PHN complications, and 6 HZ deaths. The incremental cost-effectiveness ratio (ICER) from the societal perspective was €48,707 per QALY gained, below a hypothetical willingness-to-pay threshold of two times the gross domestic product per capita per QALY gained (equivalent to €62,200). This base-case ICER was most sensitive to the annual incidence of initial HZ. In the scenario analysis, exploring higher HZ incidence based on Portuguese data, the estimated ICER was €41,877 per QALY gained. In both the base-case and the scenario analyses, ICERs were lowest in individuals aged 65–69 years, with ICERs ranging from €36,207 to €42,700 per QALY gained, in the scenario analysis and base case, respectively.

Conclusions

RZV presents a cost-effective option for the prevention of HZ and its complications in Portuguese adults aged ≥ 65 years, with greater cost effectiveness in those aged 65–69 years.