Cost-effectiveness of the recommendations of ACIP on immunization practices for the RZV

Colleagues at the Cleveland Clinic's Center for Value-based Care Research examined the cost-efficacy of new recommendations governing shingles vaccination.

Colleagues at the Cleveland Clinic's Center for Value-based Care Research examined the cost-efficacy of new recommendations governing shingles vaccination. CDC's Advisory Committee on Immunization Practices (ACIP) last year moved away from the live attenuated zoster vaccine (ZVL) in favor of a new recombinant adjuvanted zoster subunit vaccine (RZV) and dropped the vaccination threshold down to age 50 years. The panel also recommended an immediate RZV booster for anyone who had already received ZVL vaccination. Phuc Le, PhD, MPH, and Michael B. Rothberg, MD, MPH, looked at the switch to RZV from a financial perspective. ACIP's decision to endorse RZV was based in part on an assumption of 100% adherence, and the Cleveland Clinic investigators believe the new approach would in fact be cost-effective under that scenario. The likelihood of patients following through with both doses, however, is not favorable, they say, citing the high cost, reimbursement issues under Medicare, the time and inconvenience of a second office visit, and fallout for some from developing a severe local reaction with the first dose. Instead, Rothberg and Le say it makes more sense economically to recommend RZV at age 55 years and a booster at least 5 years after ZVL vaccination.