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Optimal Strategy for Herpes Zoster Vaccine

Vaccine; ePub 2018 Jul 19; Harvey, et al

Publish date:

There may be an upper limit to the optimal age of herpes zoster (HZ) vaccination for both men and women, a recent study found. Researchers sought to determine the optimal strategy for the HZ vaccine in adults by simulating cohorts of men and women and using stochastic dynamic programming to evaluate the decision to vaccinate or defer each year from age 50 to 100. If the decision was to defer, the cohort risked developing HZ. If HZ occurred, the cohort was subjected to cost and quality-adjusted life year (QALY) loss for a typical HZ infection at that age. If HZ did not occur, the decision was evaluated at the next age. A set of problematic sensitivity analyses were then conducted to check model robustness. Among the findings:

  • The optimal policy for women is to vaccinate between ages 66 and 77 and for men between ages 66 and 74, assuming a willingness to pay (WTP) of $100,000 per QALY.
  • It becomes optimal to vaccinate earlier if a booster vaccine is available, and women have a wider range of ages vs men.
  • Study findings are potentially valuable for future recommendations given that it shows a narrower range where the vaccine is most likely to be optimal.

Citation:

Harvey MJ, Denton BT, Prosser LA, Hutton DW. Determining the optimal strategy for the herpes zoster vaccine in adults. [Published online ahead of print July 19, 2018]. Vaccine. doi:10.1016/j.vaccine.2018.06.059.

Commentary:

This study looked at the mathematical algorithm to determine the best age to receive the herpes zoster vaccine. The live herpes zoster vaccine (Zostavax) was recommended by ACIP to be given as a single vaccine at age 60. The FDA approved this vaccine to be given as young as 50 years of age. In reviewing all the data, the researchers found 66 years to be the optimal age of administration. On a practical level, with most of our patients using Medicare as their primary insurer after the age of 65, getting this vaccine reimbursed is often a challenge. In 2017, the ACIP gave a preferential recommendation to the new recombinant adjuvant zoster vaccine over the live zoster vaccine. This new vaccine is given via 2 doses over the age of 50. There is currently a production shortage of this new vaccine. Based on this study I would recommend giving recombinant adjuvant zoster vaccine to standard risk patients at the age of 60 until a full supply is available. —John Russell, MD

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