Home Medizin Pandemie- und Kosteneinschränkung bei der Verwendung von Gürtelrose-Impfstoffen

Pandemie- und Kosteneinschränkung bei der Verwendung von Gürtelrose-Impfstoffen

von NFI Redaktion

Since its introduction, the Shingrix vaccine has been hailed as a breakthrough in preventing shingles. However, the path to widespread acceptance has been riddled with obstacles, from pandemic-related disruptions to insurance complexities. The consequences can be seen in vaccination rates: According to a 2022 Government Accountability Office report, only about 30% of eligible adults have received Shingrix.

Health experts advocate for its use and emphasize its unparalleled effectiveness in protecting against the painful disease.

„Shingles is one of the most common infectious causes of disability worldwide, and we now have a vaccine that shows immediate and strong efficacy against it,“ said Kenneth Koncilja, MD, a specialist at the Center for Geriatric Medicine at the Cleveland Clinic. „But since its release, there has been a very murky situation for several reasons, making things more complicated.“

Shingrix, a two-dose vaccine against shingles approved by the FDA in 2017, has been touted as a much more effective alternative to its predecessor, Zostavax.

The CDC estimates that about one in three people in the United States will develop shingles. Of those, approximately 10 to 18% will experience nerve pain or postherpetic neuralgia (PHN) – a burning pain in nerves and skin – that can last for years after the rash has cleared. Other possible complications include severe eye, heart, and neurological problems, even leading to death.

According to a study published in a specialty journal, there can also be an almost 30% increased risk of cardiovascular events such as heart attack or stroke.

While Zostavax reduced the risk of shingles by 51%, the effectiveness of Shingrix in people aged 50 to 69 increased to 97% and to 91% in those over 70. It is also about 90% effective in all age groups in preventing postherpetic neuralgia, compared to 67% with Zostavax in people aged 50 to 69.

In 2017, the concept of a second dose of the vaccine was daunting for many, exacerbated by the out-of-pocket costs. „This was long before COVID-19, and at that time many people didn’t even know what the term ‚booster‘ meant,“ said Koncilja. High prices were a significant barrier. Many Medicare Part D prescription drug plans required a copayment for the shingles vaccine. According to a report to Congress from the Medicare Payment Advisory Commission in 2019, the two required doses of the vaccine could cost more than $400 if a Medicare beneficiary had not met their deductible.

This changed in 2023 when Congress eliminated cost-sharing for vaccines endorsed by the CDC Advisory Committee on Immunization Practices for adults. This policy applies regardless of whether individuals have drug coverage through Part D or a Medicare Advantage plan, including the shingles vaccine.

„The costs were high, and there was an early shortage,“ said Dr. Tina Ardon, a primary care physician at the Mayo Clinic in Jacksonville, Florida. „Some people could only get one chance.“

Concerns about potential side effects served as another deterrent. According to the CDC, the vaccine can cause arm pain, redness, and swelling at the injection site, fatigue, muscle aches, headaches, chills, fever, stomach pain, or nausea in patients. These side effects can last 2 to 3 days.

The COVID-19 pandemic added another layer of complexity, fueling vaccine hesitancy and lowering vaccination rates. Among adults with commercial insurance coverage, vaccine claims were reportedly 15% lower in December 2020 than in December 2019, and 62% lower in April 2021 than in April 2019.

„Does the vaccine work? Yes, it works incredibly well,“ said Dr. Timothy Brewer, Professor of Medicine in the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA. „It’s really great to have a vaccine for this population that works so well. I hope that acceptance improves.“

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