Real-world utilization and potential clinical and economic value of recombinant zoster vaccine and select preventive services recommended for older adults in the United States

OBJECTIVE: To compare the real-world utilization and potential clinical and economic value of recombinant zoster vaccine (RZV) with five selected preventive services (influenza, pneumococcal, tetanus-diphtheria/tetanus-diphtheria-pertussis (Td/Tdap), and hepatitis B vaccination and colorectal cancer (CRC) screening) recommended for adults aged ≥50 years in the United States. METHODS: In this targeted literature review, EMBASE, Medline, and Emcare were searched for the most relevant publications during 2012-2022 that included utilization, clinical, and economic data for RZV and the five most relevant comparator preventive services. RESULTS: Of 8755 articles identified, the most relevant 72 were analyzed. Utilization among adults aged ≥50 years of 2-dose RZV (10.8 % in 2020) was lower than hepatitis B (19.1 % in 2018), influenza (54.2-75.2 % in 2020), (Td/Tdap) (56.5-69.8 % by age in 2019), and pneumococcal (67.5 % in 2020; ≥65 years) vaccines, and (CRC) screening (74.2 % in 2020). From economic modeling studies, estimated incremental cost-effectiveness ratios per quality-adjusted life-year were $1407-91,156 for RZV versus no herpes zoster vaccination (age ≥50 years), $8833-15,001 for influenza vaccines versus not (age ≥65 years), $17,150-336,108 for Tdap versus Td vaccines (i.e., the impact of adding protection against pertussis; age ≥65 years), $371,606-541,461 for hepatitis B vaccines versus not (age ≥50 years), $15,000-38,000 for pneumococcal vaccines versus not (age ≥50 years), and dominant to $261,000 for CRC screening versus not (age ≥50 years). CONCLUSIONS: The clinical and economic value of RZV appears to be similar or superior to the other analyzed preventive services recommended for people aged ≥50 years in the United States, but, despite this, utilization is more limited.