The Health Information and Quality Authority (HIQA) has released a health technology assessment (HTA) of the shingles vaccination (herpes zoster) for adults, following a public consultation from March 19 to April 30. This assessment, requested by the Department of Health and based on a clinical recommendation from the National Immunisation Advisory Committee (NIAC), aims to inform a policy decision on including the shingles vaccine in Ireland’s adult immunisation programme.
Dr. Conor Teljeur, HIQA’s Chief Scientist, expressed gratitude to those who participated in the public consultation. “The input we received was carefully considered in this final assessment, and much of it is reflected in sections regarding the burden of the disease, patient aspects, and social aspects,” he said. The assessment concludes that while the shingles vaccine is safe and effective, its benefits decrease over time. At the current vaccine price, adding shingles vaccination to the routine immunisation schedule for the general population aged 50 years and older would not be an efficient use of Health Service Executive (HSE) resources. This conclusion is based on a detailed analysis of the vaccine’s cost-effectiveness and its long-term efficacy.
Shingles, caused by the same virus as chickenpox, leads to a painful, blister-like rash. Although most people recover within a month, some experience severe disease or prolonged pain. Public consultation feedback highlighted the significant impact on individuals with long-term complications. Currently, shingles vaccines are available in Ireland, but the HSE does not provide free vaccination; individuals must pay for it. The economic burden of shingles, particularly on older adults and those with chronic health conditions, makes the case for considering the vaccine’s inclusion in the immunisation programme more compelling, despite the current cost constraints.
Impact on Older and Immunocompromised Populations
The incidence and severity of shingles increase with age, particularly in those over 50. Immunocompromised individuals are also at higher risk of shingles and severe disease. HIQA assessed the impact of providing shingles vaccination for adults aged 50 and older and for those aged 18 and older who are at increased risk due to immunocompromising conditions or treatments. The findings suggest that, although beneficial, the current cost of the vaccine makes widespread implementation for these groups economically unfeasible under current HSE resource constraints. This poses a significant challenge as the population ages and the number of individuals with compromised immune systems rises, increasing the potential healthcare burden from shingles outbreaks.
Shingles can have a significant impact on quality of life, particularly for older adults and those with weakened immune systems. The painful rash and potential for long-term complications make vaccination an important consideration for these populations. However, the economic assessment by HIQA indicates that the benefits must be weighed against the cost, particularly given the decreasing efficacy of the vaccine over time. Ensuring that vulnerable populations are protected without overstretching healthcare resources remains a delicate balance that policymakers must navigate.
Policy Implications and Next Steps
This HTA has been submitted as advice to the Minister for Health to inform a policy decision on whether to include shingles vaccination in the adult immunisation programme. The decision will consider the HTA findings, public consultation feedback, and the broader context of healthcare resource allocation. If approved, the shingles vaccine could become part of the routine immunisation schedule, potentially improving health outcomes for older adults and immunocompromised individuals. The inclusion of the vaccine in the immunisation programme would represent a significant step forward in public health, providing much-needed protection against a debilitating condition and reducing the long-term healthcare costs associated with treating shingles complications.
HIQA’s assessment provides a comprehensive analysis of the potential benefits and challenges of implementing a shingles vaccination programme. It highlights the importance of considering both clinical effectiveness and economic efficiency in healthcare decision-making. The outcome of this policy decision will have significant implications for public health strategy and resource allocation in Ireland. The thorough evaluation by HIQA serves as a model for how health technology assessments can guide evidence-based policy decisions that balance patient needs with economic realities.
The publication of HIQA’s HTA on the shingles vaccine represents a critical step in evaluating its potential inclusion in Ireland’s national immunisation programme. The assessment underscores the need for careful consideration of both the clinical benefits and economic impact of vaccination. As the Department of Health reviews the findings and public feedback, the decision will shape future healthcare policy and the management of shingles among vulnerable populations. Ensuring that the healthcare system can sustainably support new interventions while maximizing patient benefits is a key challenge that this HTA seeks to address.
Resource: Health Information and Quality Authority, July 19, 2024
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