Recombinant Zoster Vaccine Cost Effective for Prevention of Shingles

A systemic review found that recombinant zoster vaccination is more cost effective than no vaccine or the previously available zoster vaccine live.

Use of the recombinant zoster vaccine (RZV) for herpes zoster (HZ) is more cost effective than no vaccine and the previous product, zoster vaccine live (ZVL), encouraging use for older Americans, according to a study published in Preventive Medicine Reports.

HZ is the virus responsible for causing chicken pox and often leads to shingles later in life. Shingles is known to produce significant pain and discomfort and may lead to post-herpetic neuralgia (PHN).

RZV and ZVL are HZ vaccines developed to prevent shingles. However, ZVL was withdrawn from the US market in 2020, sparking an interest in the cost effectiveness of RZV.

Researchers conducted a systematic review to evaluate the cost effectiveness evidence of HZ vaccines in the United States, with a particular focus on RZV.

The investigators analyzed published US studies that evaluated the cost effectiveness of HZ vaccines. Eligibility criteria included studies on the cost effectiveness of RZV and ZVL, published between 2015 and 2021.

Researchers identified 11 studies assessing the cost effectiveness of HZ vaccines that met the inclusion criteria. Of these, 4 studies exclusively used ZVL. All 7 studies with RZV used ZVL as a comparator, and all 11 studies incorporated health systems costs.

Ten of the studies conducted their analyses from a societal perspective and included indirect costs. To measure effectiveness, 10 studies used quality-adjusted life years, 4 used shingles cases averted, 2 employed deaths prevented, and 1 used life years saved.

The analyses found that RZV was more cost effective than no vaccine across a range of groups. All studies that compared RZV with no vaccine found RZV vaccination is a cost effective strategy to prevent shingles and PHN episodes.

The analyses demonstrated that RZV dominated ZVL, supporting the removal of ZVL from the US marketplace in November 2020. However, compliance with the second dose of RZV is crucial to obtain the full benefits of the vaccine.

Additionally, some variation was noted in the cost effectiveness between age categories across studies.

Only 1 study met less than 90% of Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria. Additionally, all 7 of the 7 publications included probabilistic sensitivity analyses. The authors assert that these attributes demonstrate that the identified cost effectiveness analyses were of high quality, encouraging confidence in the results supporting the cost effectiveness of RZV.

Collectively, the findings of these analyses demonstrate that RSV is more cost effective than no vaccine and the previous product, ZVL.

The authors suggest that the use of RZV vaccines should be encouraged by health systems, clinicians, and advocacy organizations for older Americans.

Additionally, the authors note that although the included studies did not conduct their analyses from a patient perspective, patients with a high deductible for their prescription drugs may consider RZV vaccination as a reasonable purchase to protect from the adverse clinical sequela of shingles and PHN, because of its cost effectiveness in preventing painful shingles or PHN episodes.

The review had some limitations. The authors acknowledge the possibility that other relevant studies have been conducted but were not identified and included in this analysis.

Also, this analysis assumes the models were constructed accurately and model variables were populated appropriately by the cited researchers.


Merideth N R, Armstrong E P. Cost-effectiveness of herpes zoster vaccines in the US: a systematic review [published online: July 22, 2022] Preventive Medicine Reports.