Cost-Effectiveness of Herpes Zoster Vaccine: Flawed Assumptions Regarding Efficacy against Postherpetic Neuralgia

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Abstract
To the Editor—Rothberg et al. [1] examined the cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia (PHN). The authors concluded that the cost-effectiveness of the herpes zoster vaccine varies substantially with patient age and often exceeds US$100,000 per quality-adjusted life-year saved. Although these conclusions are dependant on a number of parameter choices that are based on limited or uncertain data (e.g., PHN-related costs, PHN incidence, and duration of vaccine efficacy [2]), one major assumption is erroneous—namely that there is no reduction in the incidence of PHN beyond that afforded by reducing the incidence of herpes zoster.