BACKGROUND: Assessing incremental clinical and economic impact of adopting novel health technology is critical for population-based decision makers (PBDMs). In October 2017, Shingrix, adjuvanted Recombinant Zoster Vaccine (RZV), was approved for herpes zoster (HZ) prevention in adults 50 years and older by the Food and Drug Administration, joining Zostavax, Zoster Vaccine Live (ZVL), as U.S.- marketed vaccines against HZ. A budget impact model was created to inform PBDMs about incremental value of RZV adoption. While a budget impact model populated using national data can inform PBDMs about the incremental value of RZV adoption overall, heterogeneity across plans highlights the need for rigorously gathered, planspecific data to enhance the relevance of the model for PBDMs in their decision-making process.
OBJECTIVE: To utilize rigorously analyzed epidemiological inputs from a large, integrated delivery network (IDN) along with nationally averaged costs data in modeling clinical and economic outcomes associated with adoption of RZV.
METHODS: A budget impact model based on the published ZOster ecoNomic Analysis (ZONA) model was created accounting for IDNcollected population characteristics (size, age distribution) and epidemiological data (incidence of HZ and complications, HZ recurrence rate), vaccine characteristics from randomized controlled trials and observational studies (efficacy, waning, 2nd dose compliance for RZV, adverse event rate), national costs averages (vaccine, direct medical for HZ and complications avoidance and vaccine adverse events), vaccine coverage and growth, and market share assumptions. Incremental clinical (HZ and complications) and economic (per-member permonth [PMPM] costs) impact at 5-, 10-, and 15-year time horizons was assessed comparing scenarios where RZV is added to one where ZVL is solely utilized.
RESULTS: For the ~1.4 million persons ≥ 50 years of age in the health plan, in the 5, 10, and 15 years following RZV adoption, approximately 8.8 thousand (k), 33.9k, and 71.6k more HZ cases and 0.8k, 3.1k, and 6.5k more cases of post herpetic neuralgia would be avoided, respectively. Across plan membership (~4.1 million persons), estimated incremental PMPM cost would be $0.41, $0.34, and $0.26, respectively.
CONCLUSIONS: RZV adoption would avoid a greater number of HZ cases and complications at a low incremental PMPM cost. The results suggest that these health gains would increase and that the costs incurred would decrease over longer time horizons.
