Cost-Effectiveness of Recombinant Versus Live-Attenuated Herpes Zoster Vaccination in China: A Modeling Study Under Self-Paid and National Immunization Scenarios

Objective: The aim was to evaluate the cost-effectiveness of self-paid vaccination using Zoster Vaccine Live (ZVL) and Recombinant Zoster Vaccine (RZV) in China, as well as their inclusion in China’s National Immunization Program (NIP), and to determine the most cost-effective initial vaccination age under this inclusion strategy. Methods: Based on the ZONA model, a Markov model was developed by incorporating pain severity levels for herpes zoster (HZ) and postherpetic neuralgia (PHN), allowing for dynamic transitions between health states. The model evaluated the cost-effectiveness of six vaccination strategies from a societal perspective. Economic evaluations were conducted using the incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and incremental cost-utility ratio (ICUR). The robustness of the results was verified through sensitivity analysis. Results: In the self-paid scenario, both RZV and ZVL were economically viable for preventing HZ. However, neither was cost-effective in preventing PHN. When included in the NIP, initiating RZV vaccination at age 50 demonstrated dominance (higher quality-adjusted life years and lower costs), with an ICER of −3826 CNY per HZ case prevented, −38,669 CNY per PHN case prevented, and an ICUR of −11,128 CNY per QALY gained. Subgroup analysis indicated that initiating RZV vaccination at age 50 offered the best cost-effectiveness, while age 70 was the most cost-saving option. Conclusions: Generally, RZV demonstrates greater cost-effectiveness compared to ZVL. Incorporating RZV into the NIP, starting at age 70, is the optimal strategy to reduce the burden of HZ and PHN and improve healthcare resource allocation in China.