Cost-effectiveness of including herpes zoster vaccines into the national immunization program in the Republic of Korea

초록

Background: Herpes zoster (HZ) vaccination is not publicly funded in Korea. This study aimed to assess the costeffectiveness of introducing recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL) into Korea's national immunization program (NIP). Methods: A decision tree Markov model was used to estimate expected costs and quality-adjusted life years (QALYs) by comparing the lifetime cost-effectiveness of NIP vaccination strategies with RZV and ZVL to that of voluntary ZVL vaccination. We analyzed people aged 50, 55, 60, 65, 70, and 75 years. The primary outcome measure was the incremental cost-effectiveness ratio (ICER) from a societal perspective. We assumed inoculation rates of 70 % for NIP and 10 % for voluntary vaccination. Results: Under the voluntary vaccination strategy, the lifetime incidence of HZ was estimated at 20.78 % at the age of 70 years, whereas it was 9.04 % for the NIP with RZV and 18.04 % for the NIP with ZVL. The ICERs for the NIP RZV strategy ranged from 15.38 to 27.87 million Korean Won (KRW) per QALY compared to voluntary vaccination, whereas the ICERs for the NIP ZVL ranged from-8.42 to 14.39 million KRW per QALY. The results were most sensitive to changes in the HZ incidence, NIP vaccine price, vaccine efficacy, and illness-related cost. Conclusion: NIP vaccination with RZV yields a significantly greater reduction in the incidence of HZ compared to vaccination with ZVL in Korea. However, NIP vaccination with ZVL is more cost-effective than vaccination with RZV, primarily due to the significantly lower cost of ZVL compared to RZV in Korea. Decisions regarding NIP vaccination policies should consider multiple factors, including cost-effectiveness, social needs, and financial sustainability, to ensure an optimal and sustainable immunization strategy.

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