Clinical Nudge Impact on Herpes Zoster Vaccine Series Completion in Pharmacies

Gatwood, Justin; Brookhart, Andrea; Kinney, Olivia; Hagemann, Tracy M.; Chiu, Chi‐Yang; Ramachandran, Sujith

doi:10.1016/j.amepre.2022.04.018

Cited by 9 publications

(11 citation statements)

References 34 publications

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“…Research has shown that barriers to HZ vaccination include vaccine distrust [ 53 ], cost concerns [ 54 , 55 ], and low perceived risk [ 55 ]. However, uptake and/or completion could potentially be improved by provider education [ 56 , 57 ], physician’s recommendations [ 55 ], nurse/pharmacy administration [ 56 ], and use of prompts/reminders [ 56 , 58 ]. Interventions such as these could help to improve uptake and/or completion, thus improving the public health impact of RZV in Canada.…”

Section: Discussionmentioning

confidence: 99%

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older

George,

Carrico,

Hicks

et al. 2024

PharmacoEconomics Open

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Objectives The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion. Methods A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs). Results The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs

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Section: Discussionmentioning

confidence: 99%

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older

George,

Carrico,

Hicks

et al. 2024

PharmacoEconomics Open

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“…Table 1 describes the characteristics of the included four RCTs studies (Heaton et al, 2022 ; Klassing et al, 2018 ; Ozdemir et al, 2023 ; Stolpe & Choudhry, 2019 ) and 15 non-RCTs studies (Abu-rish et al, 2021 ; Are et al, 2022 ; Bacci et al, 2019 ; Bayraktar-Ekincioglu et al, 2022 ; Cebollero et al, 2020 ; Deslandes et al, 2020 ; Fathima et al, 2021 ; Gatwood et al, 2022 ; Goldsworthy et al, 2022 ; Goode et al, 2023 ; Howe et al, 2022 ; Page et al, 2020 ; Rihtarchik et al, 2018 ; Scherrer et al, 2020 ; Villaverde Piñeiro et al, 2022 ). Two RCTs (Klassing et al, 2018 ; Stolpe & Choudhry, 2019 ) which were both conducted in the USA, evaluated the impact of technology-based systems that facilitated the advocacy strategies of pharmacists in identifying patients for vaccine recommendations.…”

Section: Resultsmentioning

confidence: 99%

“… Influenza Number of vaccine recipients 6 years ≥18 635,957/552,966 Critical risk Fathima et al, 2021 Australia Non-RCT a Community c Advocator f,i Monitoring system l Consultant pharmacists provided referrals to GP for patients who had overdue vaccinations for influenza and pneumonia at visit 1 (baseline) and prompt the patient for immunisation at visti 2 and 3. Comparison: Usual care Influenza Pneumococcal Number of vaccine recipients 6 months 40–80 27/37 Serious risk Gatwood et al, 2022 United States Non-RCT a Community c Advocator i /Immuniser Monitoring system j A record system (code) able to detect first dose and provide alert for second dose adminisration (at least 8 weeks post 1st dose). The alert will be notified untill 2nd dose is given or after 6 months.…”

Section: Resultsmentioning

confidence: 99%

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis

Rahim,

Dom,

Hamzah

et al. 2023

Journal of Pharmaceutical Policy and Practice

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Background Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake. Objective To evaluate the influence of pharmacist interventions on public vaccination rate. Methods SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed. Results Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)]. Conclusion While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.

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“…Indeed, studies conducted among US pharmacies have shown that reminders from pharmacists improve completion rates of HZ vaccinations. 30 , 31 …”

Section: Discussionmentioning

confidence: 99%

Attitudes, barriers, and facilitators to adherent completion of the recombinant zoster vaccine regimen in Canada: Qualitative interviews with healthcare providers and patients

George,

Regan,

Awan

et al. 2024

Human Vaccines & Immunotherapeutics

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This qualitative, cross-sectional study aimed to understand the barriers and facilitators related to the adherence and completion of the recombinant zoster vaccine (RZV) two-dose series in Canada, as perceived by healthcare providers (HCPs) and patients. Data collection occurred via 60-minute concept elicitation interviews with 12 HCPs (4 physicians, 2 nurse practitioners, 6 pharmacists) who had prescribed and/or administered RZV in Canada, and 21 patients aged ≥50 years who had received ≥1 dose of RZV. Patients were categorized as adherent (received both doses within the recommended 2-to-6-month timeframe; n = 11) or non-adherent (received only one dose or second dose outside the recommended timeframe; n = 10). Interview transcripts were coded and analyzed using a two-part thematic analysis approach. HCP-identified barriers to RZV adherence included high out-of-pocket cost, inconsistent/lack of health plan coverage, inconvenient processes for accessing RZV, and patient forgetfulness. HCP-identified facilitators included desire for shingles protection, HCP encouragement, and reminders. Barriers to RZV adherence identified by patients included lack of HCP knowledge/experience with RZV, receiving unreliable/confusing information, having unpleasant/severe side effects following the first dose, high out-of-pocket cost, lack of insurance coverage, and forgetfulness. Patient-identified facilitators included self-motivation, financial support, convenient processes for obtaining RZV, and reminders. In conclusion, many factors can influence RZV series completion and adherence among adults in Canada, including cost, insurance coverage, HCP knowledge and encouragement, and reminders. Awareness of these factors may inform HCPs in helping patients overcome barriers and identify opportunities for future consideration, facilitating protection against herpes zoster.

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Clinical Nudge Impact on Herpes Zoster Vaccine Series Completion in Pharmacies

Cited by 9 publications

References 34 publications

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis

Attitudes, barriers, and facilitators to adherent completion of the recombinant zoster vaccine regimen in Canada: Qualitative interviews with healthcare providers and patients

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