Anyone who has had chickenpox is at risk for shingles. The virus that causes chickenpox, herpes zoster, can lurk in the body long after the active disease has ended. Then, decades later, it can be reactivated and affect some nerve path(s), often causing extremely painful itching and blisters along the path those nerves follow. Even after the initial outbreak has healed, severe pain may persist a condition known as postherpetic neuralgia (PHN).
The good news is that there is now an effective vaccine, Zostavax, that can prevent shingles. But who should be getting the shot? Currently it is approved for people over the age of 50, but the CDC's Advisory Committee on Immunization Practices (ACIP) doesn't recommend it for people under the age of 60. Is this a reasonable restriction?
Drs. Phuc Le and Michael B. Rothberg of the Cleveland Clinic investigated this issue by determining the cost-effectiveness of the shingles vaccine when given to people between the ages of 50 and 59. They determined the number of cases of shingles and PHN prevented for those in this age group, and the incremental cost per quality-adjusted life year (QALY) saved.
A little background is useful here. Usually, a preventive treatment such as a vaccine, is considered cost-effective if it costs at most $100,000 per QALY, i.e., per year of healthy life gained. These investigators calculated that for 1,000 people who received the vaccine at age 50, it prevented only 25 cases of shingles and one case of PHN. Thus the new analysis found that the cost per QALY for this vaccine in this age group was over $300,000.
Dr. Rothberg noted that the shingles vaccine is protective for only 10 to 12 years. He was quoted as saying, "if you get vaccinated when you're 50, you re pretty much unprotected by 60."
Dr. Ruth Kava, Senior Nutrition Fellow at the American Council on Science and Health, senior nutrition fellow, explains that "this study was not designed to determine whether or not the vaccine prevents shingles we already know that it can. The point is that shingles is more often seen in the over-6o age group. And because in that group it prevents more cases, it is more cost-effective to use it. That's the basis on which the ACIP made its recommendation. People in the 50-59 age group can still obtain the vaccine if they wish to do so, however it may not be covered by health insurance."
