scholarly journals 20. Cost-Effectiveness of Recombinant Zoster Vaccine for Vaccinating Immunocompromised Adults Against Herpes Zoster in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S134-S134
Author(s):  
Desmond Curran ◽  
Ahmed Salem ◽  
Stéphane Lorenc ◽  
Brandon Patterson ◽  
Justin Carrico ◽  
...  
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Cost Effectiveness ◽  
The United States ◽  
Hypothetical Cohort ◽  
Cell Transplant ◽  
Renal Transplant Recipients ◽  
Zoster Vaccine ◽  
Scenario Analyses ◽  
Recombinant Zoster Vaccine

Abstract Background Individuals who are immunocompromised (IC) due to disease or therapy are at increased risk of herpes zoster (HZ), with HZ cases in IC populations also resulting in increased health care resource use and costs as compared with the immunocompetent population. This study assesses the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adults aged ≥ 18 years in the United States (US). Methods A Markov model with a one-year cycle length was developed to follow a hypothetical cohort of one million IC individuals for a 30-year time horizon. The model estimates health and cost outcomes associated with RZV versus no vaccine. The base-case analysis considered hematopoietic stem cell transplant (HSCT) recipients who were assumed to remain IC for five years post-transplant. Second-dose compliance was assumed to be 100%, with efficacy and waning inputs based on clinical trial data. Epidemiological, cost, and utility inputs were obtained from standard US sources and published literature. Costs and quality-adjusted life-years (QALYs) were discounted at 3% per year. Sensitivity, threshold, and scenario analyses were conducted, including scenarios of four other IC conditions. Results In the modeled hypothetical cohort of one million HSCT recipients, RZV resulted in 116,790 fewer HZ cases and 21,446 fewer postherpetic neuralgia cases versus no vaccine, 5,545 fewer QALYs lost and a societal cost-savings of &5.4 million. The number needed to vaccinate to prevent one HZ case was estimated to be 9. HSCT population results were shown to be robust in sensitivity and threshold analyses. In scenario analyses, RZV was cost saving for renal transplant recipients. Incremental cost-effectiveness ratios for other IC populations were &33,268 per QALY gained for human immunodeficiency virus, &67,682 for breast cancer, and &95,972 for Hodgkin lymphoma. Conclusion Results suggest that RZV is a cost-effective option for vaccinating US IC adults for the prevention of HZ and associated complications. Disclosures Desmond Curran, PhD, The GSK group of companies (Employee, Shareholder) Ahmed Salem, MSc, The GSK group of companies (Employee) Stéphane Lorenc, NA, GSK group of companies (Consultant) Brandon Patterson, PharmD, PhD, GSK group of companies (Shareholder) Justin Carrico, BS, GSK group of companies (Consultant)RTI Health Solutions (Employee) Katherine A. Hicks, MS, BSPH, GSK group of companies (Consultant)RTI Health Solutions (Employee) Elizabeth M. La, PhD, The GSK group of companies (Employee, Shareholder) Sara Poston, PharmD, The GSK group of companies (Employee, Shareholder) Christopher F. Carpenter, MD, MHSA, GSK group of companies (Consultant)

scholarly journals Cost-effectiveness of an adjuvanted recombinant zoster vaccine in older adults in the United States who have been previously vaccinated with zoster vaccine live

2019 ◽  
Vol 15 (4) ◽  
pp. 765-771 ◽  
Author(s):  
Desmond Curran ◽  
Brandon J. Patterson ◽  
Desiree Van Oorschot ◽  
Philip O. Buck ◽  
Justin Carrico ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Cost Effectiveness ◽  
The United States ◽  
Zoster Vaccine ◽  
Recombinant Zoster Vaccine

scholarly journals Cost-effectiveness of an Adjuvanted Recombinant Zoster Vaccine in older adults in the United States

Vaccine ◽  
2018 ◽  
Vol 36 (33) ◽  
pp. 5037-5045 ◽  
Author(s):  
D. Curran ◽  
B. Patterson ◽  
L. Varghese ◽  
D. Van Oorschot ◽  
P. Buck ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Cost Effectiveness ◽  
The United States ◽  
Zoster Vaccine ◽  
Recombinant Zoster Vaccine

Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

2008 ◽  
Vol 29 (12) ◽  
pp. 1157-1163 ◽  
Author(s):  
Mitesh S. Patel ◽  
Achamyeleh Gebremariam ◽  
Matthew M. Davis
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Hospital Charges ◽  
Varicella Vaccination ◽  
Severe Illness ◽  
Zoster Vaccine ◽  
Hospital Discharges ◽  
Total Charges

Objective.With childhood varicella vaccination in the United States have come concerns that the incidence of herpes zoster may increase, because of diminishing natural exposure to varicella and consequent reactivation of latent varicella zoster virus. We wanted to estimate the rate of herpes zoster-related hospitalizations and the associated hospital charges before and during the promotion of varicella vaccination in the United States.Design.A retrospective study of patients from the Nationwide Inpatient Sample for the years 1993–2004 who were hospitalized due to herpes zoster infection.Methods.We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revison, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993–2004. We designed our analysis to examine the rates of severe illness due to herpes zoster that resulted in hospitalization, as measured by the rates of herpes zoster-related hospital discharges (HZHDs). The annual population-adjusted rate of HZHDs (per 10,000 US population) and the annual inflation-adjusted total charges for HZHDs were the primary outcomes. Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. Varicella-related hospital discharges (VRHDs) were identified by use of similar diagnosis-based methods, which were described in our previous study.Results.Population-adjusted rates of HZHDs did not change significantiy from the prevaccination years (1993–1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine–eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. The annual rate of VRHDs and the associated hospital charges decreased significantly from 1993 through 2004, but the decrease in hospitalizations and charges for VRHDs was less than the increase in hospitalizations and charges for HZHDs.Conclusions.AS the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Herpes zoster vaccine may mitigate these trends for HZHDs.

scholarly journals Impact of Post-Hematopoietic Cell Transplant (HCT) Survival on Cost-Effectiveness of CPX-351 Versus 7+3 in the Treatment of Therapy-Related AML or AML-MRC in the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5837-5837
Author(s):  
Anuraag Kansal ◽  
Odette Reifsnider ◽  
Lora Todorova ◽  
Anna Coughlan ◽  
Kathleen F. Villa
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
The United States ◽  
Cell Transplant ◽  
Employment Equity ◽  
Treatment Pathways ◽  
Life Years ◽  
Equity Ownership ◽  
The Impact

Abstract Background: A central goal of treatment for high-risk AML is enabling patients to receive HCT. CPX-351 is a dual-drug liposomal encapsulation of cytarabine and daunorubicin at a synergistic ratio. A large randomized, open-label, multicenter, phase 3 trial demonstrated superior outcomes, including significantly longer overall survival and a larger fraction of patients reaching HCT, for CPX-351 versus conventional cytarabine/daunorubicin (7+3 regimen) in patients aged 60 to 75 years with newly diagnosed therapy-related AML (tAML) or AML with myelodysplasia-related changes (AML-MRC; Lancet JE, et al. J Clin Oncol. 2018). In order to estimate the cost-effectiveness of treatments for AML, and for CPX-351 in particular, it is necessary to extrapolate survival of patients undergoing HCT to the long-term. The objective of this analysis was to assess the impact of different estimates of post-HCT mortality on cost-effectiveness of CPX-351. Methods: An existing economic model of CPX-351 versus 7+3 for the treatment of tAML or AML-MRC was used to project lifetime health and cost outcomes. The modeled population included 30% patients <60 years of age and 70% between 60 and 75 years of age. The model uses a survival-partition approach, with distinct survival curves for cohorts defined by treatment pathways (response and transplantation). Projected life expectancy for each cohort was estimated based on trial data (for those 60-75 years of age), US population life-tables, and published data. For patients younger than age 60, response rates were adjusted based on published literature. Standardized mortality ratio (SMR) values following HCT were selected individually for the younger and older cohorts. SMR values were calibrated in the model to match the literature finding that post-HCT mortality results in a loss of approximately 30% of life expectancy. This yielded an SMR of 2.25 for older patients and 4.0 for younger patients. Values ranged from 1.0 to 4.0 in sensitivity analyses based on recent appraisals by the United Kingdom's National Institute for Health and Care Excellence (NICE). Model outputs included survival, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio (ICER). Results: In the base case with different SMR values by age, the model yielded a predicted ICER value of $111,841/QALY in the overall cohort, which compares favorably to the typical $150,000/QALY threshold (Bae 2014) for good value care in the United States. Using the same estimates of SMR in all patients yielded ICER values of $125,280/QALY and $151,793/QALY for SMR values of 2.25 and 4.0, respectively. Assuming no excess mortality post-HCT relative to the general population, using an SMR of 1.0, resulted in modest improvements in cost-effectiveness (ICER = $102,298/QALY). Conclusions: CPX-351 is a cost-effective option for the treatment of patients with tAML or AML-MRC when accounting for potentially increased mortality following HCT. Disclosures Kansal: Jazz Pharmaceuticals: Consultancy. Reifsnider:Jazz Pharmaceuticals: Consultancy. Todorova:Jazz Pharmaceuticals: Employment, Equity Ownership. Coughlan:Jazz Pharmaceuticals: Consultancy. Villa:Jazz Pharmaceuticals: Employment, Equity Ownership, Other: Stock and stock options.

scholarly journals Effectiveness of the recombinant zoster vaccine in adults aged 50 and older in the United States: a claims-based cohort study

2021 ◽  
Author(s):  
Yuwei Sun ◽  
Eric Kim ◽  
Christina L Kong ◽  
Benjamin F Arnold ◽  
Travis C Porco ◽  
...  
Keyword(s):  
Cohort Study ◽  
Herpes Zoster ◽  
Vaccine Coverage ◽  
The United States ◽  
Vaccine Effectiveness ◽  
Administrative Claims ◽  
Zoster Vaccine ◽  
Immunization Rates ◽  
History Of ◽  
Recombinant Zoster Vaccine

Abstract Background The recombinant zoster vaccine had over 90% efficacy in preventing herpes zoster in clinical trials. However, its effectiveness outside of a clinical trial setting has not been investigated. This study aimed to assess the effectiveness of the recombinant zoster vaccine in general practice. Methods A de-identified administrative claims database, the OptumLabs ® Data Warehouse, was used to conduct this retrospective cohort study to assess the effectiveness of the recombinant zoster vaccine against herpes zoster in non-immunocompromised, vaccine age-eligible individuals enrolled in the database for ≥365 days. Results A total of 4 769 819 adults were included in this study, with 173 745 (3.6%) adults receiving two valid doses of the recombinant zoster vaccine. The incidence rate of herpes zoster was 258.8 (95% CI: 230.0 to 289.4) cases per 100 000 person-years in vaccinated persons compared to 893.1 (95% CI: 886.2 to 900.0) in unvaccinated. Recombinant zoster vaccine effectiveness was 85.5% (95% CI: 83.5% to 87.3%) overall, with an effectiveness of 86.8% (95% CI: 84.6% to 88.7%) in individuals 50 to 79-years-old compared to 80.3% (95% CI: 75.1% to 84.3%) in individuals ages 80 and older. In patients with a history of live zoster vaccine within 5 years of study inclusion, vaccine effectiveness was 84.8% (95% CI: 75.3% to 90.7%). Conclusions Recombinant zoster vaccine effectiveness against herpes zoster was high in a real-world setting. Given the low vaccine coverage and high effectiveness, a major public health effort is needed to identify and address barriers to vaccination and increase immunization rates.

scholarly journals 12. Modeled Impact of the COVID-19 Pandemic and Associated Reduced Adult Vaccinations on Herpes Zoster in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S130-S130
Author(s):  
Elizabeth M La ◽  
Desmond Curran ◽  
Ahmed Salem ◽  
David Singer ◽  
Nicolas Lecrenier ◽  
...  
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Health Care Providers ◽  
Clinical Trial Data ◽  
The United States ◽  
Care Providers ◽  
Vaccine Preventable Diseases ◽  
Scenario Analyses ◽  
Life Years ◽  
The Impact

Abstract Background During the COVID-19 pandemic, adult vaccination in the United States (US) decreased substantially in 2020. Unlike other vaccine-preventable diseases where individuals may have experienced reduced risk due to COVID-related mitigation efforts (e.g., lockdown restrictions, use of face masks), individuals remained at risk of herpes zoster (HZ). This study projects the impact of reduced recombinant zoster vaccine (RZV) use on HZ cases and complications in the US. Methods A multi-cohort Markov model estimated the impact of missed RZV vaccinations, by comparing scenarios with and without missed vaccinations between Apr-Dec 2020, on cases of HZ, postherpetic neuralgia (PHN), and quality-adjusted life-years (QALYs) among US adults aged ≥ 50 years. Epidemiology, RZV efficacy, and utility inputs were obtained from standard US sources, clinical trial data, and published literature. Missed doses were estimated using data on RZV doses and an assumed 43% reduction in RZV vaccinations during the pandemic, based on publicly available data. Deterministic sensitivity and scenario analyses were conducted. Results In 2020, approximately 21 million (M) RZV distributed doses were expected, including an estimated 9.2M RZV series initiations in Apr-Dec. An estimated 3.9M RZV series initiations were missed, resulting in 31,945 projected HZ cases, 2,714 PHN cases, and 610 lost QALYs projected over a 1-year follow up. If individuals with missed RZV initiations remain unvaccinated in 2021, avoidable HZ cases will increase to 63,117 over 2 years. Further, if the same number of RZV initiations are missed in 2021, 95,062 avoidable HZ cases are expected. In a sensitivity analysis assuming 30% RZV reduction, 18,020 avoidable HZ cases and 1,531 PHN cases were observed over 1 year. Conclusion Adding to the substantial COVID-19 infection-related morbidity and mortality, reduced RZV use during the pandemic resulted in further burden from avoidable HZ cases. Health care providers should continue to emphasize the importance of vaccination against HZ and other preventable diseases during the pandemic. Funding GlaxoSmithKline Biologicals SA (GSK study identifier: [VEO-000222]). Acknowledgement Business & Decision Life Sciences c/o GSK (Coordination: Quentin Rayée). Disclosures Elizabeth M. La, PhD, The GSK group of companies (Employee, Shareholder) Desmond Curran, PhD, The GSK group of companies (Employee, Shareholder) Ahmed Salem, MSc, The GSK group of companies (Employee) David Singer, PharmD, MS, The GSK group of companies (Employee) Nicolas Lecrenier, Ing, PhD, The GSK group of companies (Employee, Shareholder) Sara Poston, PharmD, The GSK group of companies (Employee, Shareholder)

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