In a cost-effectiveness analysis of vaccination for the prevention of herpes zoster, vaccination with recombinant zoster vaccine (RZV) yielded cost-effectiveness ratios lower than those for many recommended adult vaccines, including zoster vaccine live (ZVL). The hypothetical cohort of immunocompetent US adults aged ≥50 years included an intervention of vaccination with RZV (recommended 2-dose regimen), vaccination with ZVL, and no vaccination. The primary outcome was the incremental cost-effectiveness ratio (ICER). Findings of the base-case analysis included:

• For vaccination with RZV compared with no vaccination, ICERs ranged by age from $10,000 to $47,000 per quality-adjusted life-year (QALY).
• For persons aged ≥60 years, ICERs were <$60,000 per QALY.
• Vaccination with ZVL was dominated by vaccination with RZV for all age groups aged ≥60 years.

In sensitivity analysis:

• Results were most sensitive to changes in vaccine effectiveness, duration of protection, herpes zoster incidence, and probability of postherpetic neuralgia.
• Vaccination with RZV after previous administration of ZVL yielded an ICER of <$60,000 per QALY for individuals aged ≥60 years.
• In probabilistic sensitivity analyses, RZV remained the preferred strategy in at least 95% of simulations.