Herpes zoster vaccine safe and effective, but cost may hinder its use

The herpes zoster vaccine is safe and effective, but financial considerations may keep clinicians from administering it, according to studies in today's Annals of Internal Medicine.

Researchers for the Shingles Prevention Study Group studied 38,546 adults 60 years and older who had a history of chickenpox but not shingles (of these, 6,616 also participated in an adverse events substudy that gathered more detailed information about early adverse events). Participants were randomly assigned to receive either the herpes zoster vaccine or a placebo and were followed for approximately three years. Adverse events were assessed at 42 days after vaccination and at three years.

Only 1.4% of both the vaccine and placebo recipients reported serious adverse events. More vaccine recipients than placebo recipients in the substudy (48% vs. 16%) reported local side effects, such as redness, swelling and tenderness. Seven participants in the vaccine group developed herpes zoster compared with 24 participants in the placebo group. Over a mean follow-up of 3.39 years, hospitalization rates and mortality rates did not differ between groups. Although the participants in the substudy were not randomly selected and serious adverse events were not always confirmed in the medical record, the authors concluded that herpes zoster vaccine is well tolerated in older, immunocompetent adults.

However, despite the vaccine's safety and effectiveness, fewer than 10% of those eligible for it actually receive it. The vaccine costs about $200, making it one of the most expensive available for adults, and is covered under Medicare Part D instead of Medicare Part B. In a second study, researchers performed a national mail and Internet-based survey of 301 general internists and 297 family medicine physicians to assess current knowledge, vaccination practices and barriers to vaccination. Of the 72% who responded to the survey, 93% reported that they make the vaccine available to their patients, 49% by stocking and administering the vaccine in their offices, 36% by asking the patient to purchase the vaccine in a pharmacy and then visit the office for vaccine administration, and 33% by referring patients to a pharmacy for vaccine administration.

Both internists and family practitioners most frequently cited financial reasons as the main barriers to vaccination. Twelve percent of respondents initially administered the vaccine in their offices but had stopped doing so because of cost and reimbursement issues. Only 45% of respondents knew how vaccine administration is reimbursed. The authors noted that the survey results might not accurately affect practice and may not represent all clinicians. However, they concluded that although physicians are trying to make herpes zoster available to their patients, they face substantial barriers, mainly financial. “Efforts to facilitate the financing of herpes zoster vaccine could help increase its use,” they wrote.