Document Type

Conference Proceeding

Publication Date


Publication Title

American Journal of Hematology


Introduction / Background / Significance: Immunocompromised (IC) populations diagnosed with cancer are at increased risk for herpes zoster (HZ) due to their underlying disease and/or therapy. This risk is highest among individuals receiving hematopoietic stem cell transplant (HSCT) to treat multiple myeloma, lymphomas, or other diseases. HZ is characterized by a painful vesicular rash. IC populations with HZ are also at increased risk of developing HZ-related complications such as postherpetic neuralgia, a persistent pain that can last for months or years. This study evaluates the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adult HSCT recipients, patients with Hodgkin lymphoma, and patients with breast cancer in the United States (US). Materials and Methods / Case Presentation / Objective: A Markov model was developed to simulate a hypothetical cohort of 1 million IC adults over a 30-year period. The model uses a one-year cycle length and estimates avoided HZ cases and complications, discounted qualityadjusted life-years (QALYs) gained, and discounted costs, comparing scenarios where individuals are vaccinated with RZV versus no HZ vaccine. The base-case analysis modeled HSCT recipients, with scenario analyses included for patients with either Hodgkin lymphoma or breast cancer. To represent younger populations, the model followed 35-yearold HSCT recipients who were assumed to remain IC for five years. Patients with Hodgkin lymphoma or breast cancer were aged 25 and 45 years, respectively, and remained IC for two years. The model assumed 100% compliance with the two-dose RZV series. RZV efficacy and waning inputs were derived from phase 3 clinical trial data. Other input values for epidemiological, cost, utility, and mortality parameters were obtained from the published literature, national survey data, Red Book, and US life tables. A number of input values, including HZ incidence, varied depending on whether individuals were IC or had returned to healthy status. Robustness of the results was assessed by sensitivity and scenario analyses. Results / Description / Main Outcome Measure(s): For the base-case 1 million hypothetical HSCT recipients, RZV vaccination resulted in 116,790 avoided HZ cases, 5,545 QALYs gained, and a societal costsavings of $5.4 million compared with no vaccine. In scenario analyses, RZV vaccination resulted in 100,104 avoided HZ cases and 2,098 QALYs gained for patients with Hodgkin lymphoma and 136,399 avoided HZ cases and 1,813 QALYs gained for patients with breast cancer. From the societal perspective, incremental costeffectiveness ratios (ICERs) for RZV vaccination were $95,972/QALY gained for Hodgkin lymphoma and $67,682 for breast cancer. For the HSCT population, ~97% of simulations from the probabilistic sensitivity analysis demonstrated ICERs less than $100,000/QALY gained. Conclusion(s): Although the risk and burden of HZ are increased in individuals diagnosed with cancer over a relatively short period, results from this study highlight the value of RZV in preventing HZ cases and improving the quality of life in the studied IC populations. Results further indicate that vaccination with RZV is a cost-effective option for the prevention of HZ and its associated complications in these IC populations in the US.





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