Shingles vaccination is likely to be cost effective at age 65 or 70

BMJ 2009; 338 doi: (Published 06 March 2009) Cite this as: BMJ 2009;338:b944
  1. Roger Dobson
  1. 1Abergavenny

    The age at which vaccination against Herpes zoster is most cost effective is 65 or 70 years, a new study indicates. Such protection could mean some 11 000 fewer cases of shingles each year in England and Wales, it estimates.

    The researchers, at the UK Health Protection Agency and Utrecht University Medical Centre, also found that adding a booster dose of the vaccine at a later stage was unlikely to be cost effective (Vaccine doi:10.1016/j.vaccine.2008.12.024).

    A live attenuated vaccine against Herpes zoster was approved for use in the United Kingdom three years ago. The UK, unlike the United States, for example, currently has no vaccination programme for Herpes zoster.

    The new study draws from original data from a clinical trial and from general practice databases and data on hospitalisation rates, mortality, and costs.

    The original trial found that the vaccine halves the number of cases of shingles in people aged over 60 years and also reduces the severity of disease. The effectiveness of the vaccine seems to decline with age, from 64% when vaccination occurs at 60-69 years to 38% among those aged over 70.

    The results show that the estimated annual number of cases in England and Wales in people aged 60 or over was 88 650 and that an estimated 18 200 people were still in pain after three months. In this age group an estimated 1750 people are hospitalised each year, and Herpes zoster is given as the cause of death in 55 cases each year.

    The study estimated that shingles generated an overall annual cost to the healthcare system of £17.3m (€20m; $24m), of which £11.5m was related to general practice and the remainder to secondary care. Almost 50% of the total costs relate to disease in people aged over 80, because of the higher incidence and likelihood of complications in this group.

    Vaccination of 65 year olds at 73.5% coverage was estimated to reduce the lifetime risk of Herpes zoster infection from 15% to 12%, or nearly 11 200 cases. It was also estimated that 1500 fewer cases of post-herpetic neuralgia, the most common complication of the condition, would occur each year and that vaccination would reduce the annual number of hospitalisations by nearly 150.

    Vaccination of 65 year olds was calculated to cost about £23.7m but would result in savings to the health service of around £1.3m over the life span of the cohort, most of which would be saved in primary care.

    “Results from this analysis suggest that [vaccination] is likely to represent a cost-effective intervention for England and Wales, although there is a lot of uncertainty around the duration and range of vaccine induced protection and the quality adjusted life year (QALY) loss due to long-term pain,” says the report.

    “The most cost effective age to vaccinate is 70 years, or 65 years if the vaccine does not offer additional protection against the severity of disease.”


    Cite this as: BMJ 2009;338:b944

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