Recombinant shingles vaccine is cost-effective for shingles prevention

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

According to a study published in Preventive medicine reports.

HZ is the virus responsible for chickenpox and often leads to shingles later in life. Shingles is known to produce significant pain and discomfort and can lead to postherpetic neuralgia (PHN).

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 However, the ZVL was withdrawn from the US market in 2020, sparking interest in the profitability of the RZV.

The researchers conducted a systematic review to assess the evidence for cost-effectiveness of shingles vaccines in the United States, with a particular focus on RZV.

Investigators analyzed published US studies that assessed the cost-effectiveness of shingles vaccines. Eligibility criteria included studies of the cost-effectiveness of VRZ and ZVL, published between 2015 and 2021.

The researchers identified 11 studies evaluating the cost-effectiveness of shingles vaccines that met the inclusion criteria. Of these, 4 studies used ZVL exclusively. All 7 studies of RZV used ZVL as a comparator, and all 11 studies included health system costs.

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

Analyzes found that RZV was more cost-effective than no vaccine across a range of groups. All studies comparing RZV versus no vaccine found RZV vaccination to be a cost-effective strategy to prevent shingles and PHN episodes.

Analyzes demonstrated that RZV dominated ZVL, supporting the withdrawal of ZVL from the U.S. market in November 2020. However, adherence to the second dose of RZV is crucial to achieving the full benefits of the vaccine.

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

Only one study met less than 90% of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria. In addition, all 7 out of 7 publications included probabilistic sensitivity analyses. The authors state that these attributes demonstrate that the business cases identified were of high quality, encouraging confidence in the results supporting the profitability of the VRZ.

Collectively, the results of these analyzes demonstrate that RSV is more cost-effective than no vaccine and the predecessor product, ZVL.

The authors suggest that the use of RZV vaccines should be encouraged by US health systems, clinicians, and seniors’ advocacy organizations.

Additionally, the authors note that although the included studies did not conduct their analyzes from the perspective of the patient, patients with high deductibles for their prescription medications may view RZV vaccination as a reasonable purchase to protect against adverse clinical sequelae of shingles and PHN because of its cost-effectiveness in preventing painful shingles or episodes of PHN.

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

Furthermore, this analysis assumes that the models have been constructed accurately and that the model variables have been appropriately populated by the cited researchers.


Merideth NR, Armstrong E P. Cost-effectiveness of shingles vaccines in the United States: a systematic review [published online: July 22, 2022] Preventive medicine reports.

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