Unlocking herpes zoster vaccination value in Spain: return on investment and actuarial model

Herpes zoster can cause long-lasting pain and productivity loss. Recombinant zoster vaccine (RZV) is included in the Spanish National Immunization Program (NIP) for 65-year-olds. This study estimated the societal benefit–cost ratio (BCR) of RZV in Spain. A cost–benefit analysis assessed the broader impacts of RZV over 50 years, using a disease model combined with actuarial projections (of population dynamics and labor force participation). The model incorporated age-specific vaccination cohorts, vaccination costs, healthcare resource use, quality-adjusted life-years (QALYs), mortality, and productivity. Productivity losses avoided were translated into gross domestic product (GDP) gains, and QALYs were monetized at 1xGDP/capita. A 20-year RZV program for 65-year-olds was modeled. Scenarios evaluated vaccination in working-age adults (50, 55, 60 years), and varied monetized QALY values. In the base case, reflecting the current NIP, vaccination of 65-year-olds generated 49,955 QALYs (€1,653.5 million, M), €899.0M healthcare costs avoided, and €354.0M GDP gains versus no vaccination. With an investment of €2,405.0M, the BCR was 1.21, indicating a positive return-on-investment. In scenarios, vaccinating working age 55- and 60-year-olds produced higher returns, from greater productivity gains (BCR 1.26). RZV in Spain provides a positive return-on-investment. Findings offer robust evidence for policymakers evaluating RZV. Recombinant zoster vaccine (RZV) is highly effective in preventing herpes zoster and postherpetic neuralgia, which increase healthcare resource use, productivity losses, and negatively impact population health. This cost–benefit analysis assessed broad RZV benefits, including health gains, healthcare cost savings, and averted productivity loss translated into gross domestic product (GDP) gains to society. Vaccinating 65-year-olds with RZV as part of Spain’s National Immunization Program produced health gains, healthcare cost-savings, and GDP gains, returning €1.21 for every €1 invested. All scenarios produced a positive return-on-investment, with higher economic benefits due to greater productivity gains in younger adults. These findings offer policy decision-makers a broader perspective of RZV economic value than traditional cost-effectiveness analyses and provide relevant information supporting potential future NIP expansion.