Cost-effectiveness of herpes zoster vaccination in patients with rheumatoid arthritis

OBJECTIVES: To assess the cost-effectiveness of vaccinating patients with rheumatoid arthritis (RA) with the adjuvanted recombinant zoster vaccine (RZV), compared with no vaccination. METHODS: To predict health gains and costs from vaccination, we developed a decision-analytic Markov model with five health states: no herpes zoster, herpes zoster (HZ), postherpetic neuralgia (PHN), recovered from herpes zoster, and death. The model follows a hypothetical cohort of 10,000 patients with RA over a lifetime perspective and records events of HZ and PHN, along with quality-adjusted life years (QALYs) and costs from a healthcare perspective. Costs and health effects were discounted with 4% annually. Model inputs were collected from published literature and publicly available sources. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), expressed as EUR per quality adjusted life year (QALY), compared with a cost-effectiveness threshold of EUR 23,650 per QALY. We performed one-way and probabilistic sensitivity analyses. RESULTS: Vaccination led to a reduction of 2,550 cases of HZ and 1,303 cases of PHN per 10,000 patients with RA vaccinated, resulting in an ICER of EUR 11,205/QALY. One-way sensitivity analyses revealed that the results were particularly sensitive to changes in the probability of developing PHN as a sequela of HZ. The probabilistic analysis indicated that the RZV had a 98% probability of being cost-effective at the assumed threshold value. CONCLUSIONS: Vaccinating patients with RA using RZV results in better health at higher cost compared with no vaccination. Under the assumptions made, vaccination is likely to be considered cost-effective for patients with RA.