Barriers to the Use of Herpes Zoster Vaccine

Hurley, Laura P.

doi:10.7326/0003-4819-152-9-201005040-00005

Cited by 108 publications

(98 citation statements)

References 23 publications

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“…The cost of HZ vaccine previously had been cited as a major obstacle to vaccination. 15 Medicare now covers the cost of the vaccine for eligible individuals. In this study of patients with mostly Medicare coverage, financial factors were cited by only a small number.…”

Section: Discussionmentioning

confidence: 99%

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Herpes Zoster Knowledge, Prevalence, and Vaccination Rate by Race

Lee

Hayes

Cummings

et al. 2013

The Journal of the American Board of Family Medicine

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Objectives: To determine the prevalence of self-reported herpes zoster (HZ) disease and vaccination in a geriatric population and to characterize the deciding factors to receive the HZ vaccine.Methods: This was a cross-sectional survey of patients older than age 60 years at 3 university-based primary care clinics in the southeastern United States. Participants provided information for age, race, sex, education level, history of having "shingles" or knowing someone else who had shingles, past vaccinations, and factors influencing their decision to receive the HZ vaccine.Results: We surveyed 403 patients (49% African American [AA], 47% white). The prevalence of HZ was 12.4% overall and was significantly different among races (8% AA, 17% white; P ‫؍‬ .01). Only 29% of patients (16% AA, 42% white; P < .001) were aware that the HZ vaccine was recommended. The HZ vaccination rate was 7.7% (2% AA, 14% white; P < .001). Only 13.7% of all study subjects reported having any communication with their medical providers regarding the HZ vaccine. Physician recommendation and media had the greatest influence on patients who received the vaccine. Of those who had not been vaccinated, 70% had never heard about it and 59% were interested in receiving the vaccine after the survey.Conclusion: There is a large difference in self-reported HZ and vaccination rates among races. The HZ vaccination rate was low overall, but most patients were interested in receiving the vaccine after the survey. More public awareness and education is needed to improve rates of HZ vaccination. Herpes Zoster (HZ), also known as shingles, is a skin condition caused by the reactivation of a latent varicella zoster virus, which is the virus that also causes chickenpox.1 HZ is most commonly seen in patients who are older than age 50, immunocompromised, or receiving immunosuppressive therapy.2 Every year, there are approximately 1 million new cases of HZ in the United States.3,4 In addition, the incidence of HZ varies among races.There is a significantly higher rate of HZ among whites compared with African Americans and Hispanics. [5][6][7] One major complication with HZ is postherpetic neuralgia, which is dermatomal pain after the resolution of rash that can be exquisitely painful and last months to even years. 8,9 In 2008, the Advisory Committee on Immunization Practices recommended that all people older than age 60 receive the zoster vaccination. 10 The vaccine is recommended without serologic testing and regardless of race or medical history of varicella virus infection or HZ. When vaccinated, the risk of having HZ, the burden of disease, and the incidence of postherpetic neuralgia decrease by 51%, 61%, and 66%, respectively, over 3 years.

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Section: Discussionmentioning

confidence: 99%

“…15 Of the vaccines recommended for the older population, the HZ vaccine is among the most expensive (approximately $150 per dose). 12,16 The purpose of this study was to determine the prevalence of HZ and the rate of vaccination among older patients now that the vaccine has been available and recommended for several years.…”

mentioning

confidence: 99%

Herpes Zoster Knowledge, Prevalence, and Vaccination Rate by Race

Lee

Hayes

Cummings

et al. 2013

The Journal of the American Board of Family Medicine

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“…In 2008, rates were lower among Hispanics (2.1%) and non-Hispanic blacks (2.5%) than nonHispanic whites (7.6%). Both patient and provider barriers have been suggested as explanations for the low uptake of the zoster vaccine, such as the high vaccine cost, complex methods for reimbursement, and requirement for freezer storage [79,80].…”

Section: Vaccinementioning

confidence: 99%

The Epidemiology and Prevention of Herpes Zoster

2012

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Herpes zoster is a common disease among older individuals, affecting approximately 25% of people in their lifetime and resulting in appreciable morbidity. The risk of zoster increases sharply with age and immunosuppression, yet relatively little is known about other risk factors for zoster. A vaccine for zoster is now available that holds the potential to reduce incidence of zoster and its complications. In this review, the recent literature on zoster incidence and potential risk factors for the disease are summarized. Current methods of preventing zoster and its associated morbidity are discussed, including zoster vaccine and the use of antivirals.

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“…Following approval of HZ vaccine, uptake has been slow, hampered by high cost, vaccine shortages and lack of familiarity. 43,44 Although vaccination rates have begun to rise, 19 the impact of a booster recommendation on vaccine supply and initial vaccination rates is unknown. One way to mitigate between these competing needs would be to focus on vaccinating all patients above age 70, whether they are unvaccinated or have been vaccinated at least 10 years ago.…”

Section: Discussionmentioning

confidence: 99%

Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis

Rothberg

2016

J GEN INTERN MED

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BACKGROUND:The Advisory Committee on Immunization Practices recommends a single dose of herpes zoster (HZ) vaccine in persons aged 60 years or older, but the efficacy decreases to zero after approximately 10 years. A booster dose administered after 10 years might extend protection, but the cost-effectiveness of a booster strategy has not been examined. OBJECTIVE: We aimed to determine the optimal schedule for HZ vaccine DESIGN: We built a Markov model to follow patients over their lifetime. From the societal perspective, we compared costs and quality-adjusted life years (QALYs) saved of 11 strategies to start and repeat HZ vaccine at different ages. SUBJECTS: Adults aged 60 years. INTERVENTION: HZ vaccine. MAIN MEASURES: Costs, quality-adjusted life years (QALYs), and incremental costs per QALY saved. KEY RESULTS: At a $100,000/QALY threshold, "vaccination at 70 plus one booster" was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of $36,648/QALY. "Vaccination at 60 plus two boosters" was more effective, but had an ICER of $153,734/QALY. In deterministic sensitivity analysis, "vaccination at 60 plus two boosters" cost < $100,000/ QALY if compliance rate was > 67 % or vaccine cost was < $156 per dose. In probabilistic sensitivity analysis, "vaccination at 70 plus one booster" was preferred at a willingness-to-pay of up to $135,000/QALY. CONCLUSIONS: Under current assumptions, initiating HZ vaccine at age 70 years with one booster dose 10 years later appears optimal. Future data regarding compliance with or efficacy of a booster could affect these conclusions.KEY WORDS: herpes zoster; cost-effectiveness; booster. J Gen Intern Med 32(2):159-67

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Barriers to the Use of Herpes Zoster Vaccine

Abstract: Centers for Disease Control and Prevention.

Cited by 108 publications

References 23 publications

Herpes Zoster Knowledge, Prevalence, and Vaccination Rate by Race

Herpes Zoster Knowledge, Prevalence, and Vaccination Rate by Race

The Epidemiology and Prevention of Herpes Zoster

Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis

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