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The adjuvanted herpes zoster subunit vaccine (Shingrix) has superior efficacy compared with the live vaccine (Zostavax), and the Advisory Council on Immunization Practices (ACIP) recommends that the adjuvanted subunit vaccine be given in preference to the live vaccine, even for individuals who have previously received live vaccine (MMWR 2018; 67:103; NEJM JW Infect Dis Jun 2015 and N Engl J Med 2015; 372:2087).
To determine the cost-effectiveness of the subunit vaccine compared with that of the live vaccine, investigators created a Markov decision model. The live vaccine was estimated to cost $212.67 per dose, and the estimate for the subunit vaccine was $280 for two doses. Depending on age, the incremental cost-effectiveness ratio per quali…