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 The Centers for Disease Control and Prevention (CDC) does not
recommend the shingles vaccine for that age group, and the authors
of the new analysis say their findings support that policy.
"Even though the vaccine is effective, it may not be cost
effective," lead author Phuc Le of the Cleveland Clinic told Reuters
Health.
Shingles, or herpes zoster, is a painful, blistering rash caused by
the same virus that causes chicken pox.
About one million Americans develop shingles each year, Le and
colleagues say. Many of them go on to have persistent severe pain
known as postherpetic neuralgia, even if they receive treatment with
antiviral drugs.
The vaccine against shingles is cleared for use among those age 50
and older, but the CDC's Advisory Committee on Immunization
Practices (ACIP) does not recommend the vaccine before age 60.
For the new study, reported in Annals of Internal Medicine, the
researchers used a computer to estimate the effectiveness of the
vaccine in people 50 to 59 years.
Overall, they calculated, for every 1,000 people receiving the
vaccine at age 50, just 25 shingles cases and one case of
shingle-related pain would be prevented.
Typically, preventive treatments are considered cost-effective when
they cost at most $100,000 per quality-adjusted life-year (QALY),
that is, per year of healthy life gained. The new analysis found the
vaccine cost over $300,000 per QALY.
Dr. Michael Rothberg, the study's senior author from the Cleveland
Clinic, said that when the vaccine is given at ages 60 or 70, its
protective effect lasts 10 to 12 years.
"If you get vaccinated when you're 50, you’re pretty much
unprotected by 60," he said.
In a statement emailed to Reuters Health, Dr. Eddy Bresnitz, the
executive director of medical affairs for adult vaccines at Merck,
said it's important not to lose sight of the impact of the disease.
Merck & Co., Inc.'s Zostavax shingles vaccine has been found to
reduce both shingles and its related pain.
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"Our FDA approved indication for Zostavax begins at age 50 and given
the demonstrated efficacy rate of 70 percent for people 50 to 59 and
safety profile of Zostavax, vaccination could help to prevent many
of these cases," Bresnitz wrote. "This may help explain why many
private insurance plans include the vaccine on formulary, in spite
of the absence of an ACIP recommendation among the 50-59 age
cohort."
If the vaccine's effectiveness lasted longer, or the price of the
drug was less, it might be cost effective, Rothberg said.
But data on the longterm efficacy for people in their 50s may take
years to be published, Le said in a follow-up email.
"The study already looks at the impact of vaccine cost," she said.
"If the vaccine were to cost $80 or less per dose, the vaccine could
be considered to represent good value for 50-year-olds. It’s
unlikely, though, that the vaccine will ever cost that little."
According to healthcarebluebook.com, a "fair price" for Zostavax in
the U.S. is $200.
Rothberg said it may be worthwhile for people who have the money to
spend.
"It’s helpful, but it's not something health plans or the government
should cover," he said. "It does benefit, but it’s just a small
benefit."
SOURCE: http://bit.ly/SQRXAa Annals of Internal Medicine, online
September 7, 2015.
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