Журнал инфекционных заболеваний и терапии

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Cost-Effectiveness Modelling Of Vaccination Strategies for the Prevention of Varicella and Herpes Zoster Infection: Summary of a Systematic Review

Brent Hodgkinson, Tianjiao Wang, Joshua Byrnes and Paul Scuffham

Background:
VZV is a vaccine preventable disease that has yet to be universally included in many countries vaccination schedules due to uncertainty over the cost-effectiveness of the vaccination strategies. Here we describe the results of a recently published systematic review of the literature that was conducted to summarise available evidence on the cost-effectiveness of VZV vaccination strategies.
Methods:
The systematic review was conducted in accordance with PRISMA guidelines and Cochrane methods.
Results:
Six cost-utility studies, all using dynamic transmission modelling (DTM) techniques were identified. All studies modelled a rapid decrease in VZV incidence following VZV vaccination and an increase in HZ incidence that could last for decades when exogenous boosting (EB) was assumed. The cost-effectiveness of VZV vaccination compared to no-vaccination ranged from being dominated when HZ increases lasted for >50 years to cost-effective ($7,000 to $61,000 in 2019 USD) and even dominant as the period where HZ incidence was elevated became shorter.
Conclusions:
The DTM models identified in the review are sensitive to EB assumptions and limited by requirements for homogeneity in infection risk within age groups. The use of agent-based models to account for the individual nature of infectiousness should be considered. Early work using an agent-based model has supported the results of DTM models identified in the original review.