Proposal to fund zoster vaccine

Medicines

Consultation Closed

PHARMAC is seeking feedback on a proposal to fund the zoster vaccine (Zostavax) for the prevention of shingles (herpes zoster) from 1 April 2018 through a provisional agreement with Merck Sharpe & Dohme Limited.

We are proposing to list the zoster vaccine in Section B and in Part II of Section H of the Pharmaceutical Schedule for people aged 65 years and with a 2-year catch up programme for people aged between 66 and 80 years inclusive.

Consultation closes at 5 pm on Wednesday, 4 October 2017 and can be emailed to vaccines@pharmac.govt.nz.

What would the effect be?

From 1 April 2018 people aged 65 years would be able to get one funded zoster vaccine from their general practitioner.

There would also be a catch-up programme where, from 1 April 2018 until 31 March 2020, people aged between 66 and 80 years old would be eligible to receive a funded zoster vaccine.

People who meet the funding criteria could receive their zoster vaccine at the same time as their annual influenza vaccine.

Patients would be able to get their funded zoster vaccine from their general practitioner. Funded zoster vaccine would not be available through community pharmacies at this point, but this may be considered in the future.

Who we think will be interested

Doctors in general practice, infectious disease specialists, geriatricians, public health services, nurses, vaccinators, DHBs, people 65 years and over, consumer groups focused on the elderly such as Grey Power and Age Concern, rest homes and retirement villages, organisations with an interest in immunisation.

About the zoster vaccine

Herpes zoster, commonly known as shingles, is caused by the reactivation of the varicella-zoster (chickenpox) virus. Anyone who has previously had chickenpox may subsequently develop shingles, and the incidence tends to be proportionally higher in older patients. Shingles is more common and more severe in patients with poor immunity.

Zostavax is indicated for the prevention of herpes zoster (shingles), for prevention of post herpetic neuralgia and for reduction of acute and chronic zoster-associated pain in people aged 50 years and older. Each 0.65 ml dose of Zostavax contains a minimum of 19,400 plaque forming units (pfu) of live Oka/Merck strain of varicella-zoster virus when reconstituted.

Zostavax vaccine is contraindicated in immunocompromised patients and healthcare professionals should assess the patient’s immunological status before vaccination (see the September 2017 Prescriber Update issued by Medsafe: http://www.medsafe.govt.nz/profs/PUArticles/PDF/PrescriberUpdate_September2017.pdf(external link)).

Zostavax can be administered concurrently with influenza vaccine.

Why we’re proposing this

A funding application for Zostavax has been reviewed by the Pharmacology and Therapeutics Advisory Committee (PTAC) and the Immunisation Subcommittee of PTAC. Funding was recommended for individuals 65 years of age, and for a 2-year catch-up programme for people aged between 66 and 80 years.

One in every three people can expect to suffer at least one attack of shingles in their lifetime. Attacks can be very painful, prolonged and debilitating, especially for older people. Shingles and post-herpetic neuralgia have high levels of morbidity, and can be life changing as some patients do not recover to the point where they are well enough to return to independent living.

Zostavax vaccination has been shown to reduce reactivation of herpes zoster virus (shingles), and prevent the development of post herpetic neuralgia.

Clinical advice carefully considered the cost and benefits of when to vaccinate with Zostavax and recommended vaccination at 65 years was the best option.

There is a significant difference in the efficacy of Zostavax depending on the age of the person when they are vaccinated, with a vaccine efficacy of around 64% for individuals aged 60-69, dropping to 38% in those aged 70 and older, and 18% in people over 80 years.

More information, including links to the PTAC and Immunisation Subcommittee minutes, can be found via PHARMAC’s Application Tracker.

Details about our proposal

PHARMAC has entered into a provisional agreement with Merck Sharp & Dohme (New Zealand) Limited to list Zostavax.

Zostavax would be listed in Section I (National Immunisation Schedule) and Part II of Section H of the Pharmaceutical Schedule from 1 April 2018 at the following price and subsidy (ex-manufacturer, excluding GST):

Chemical Presentation Brand Pack size Subsidy Manufacturer’s price (ex GST)
Varicella zoster virus (Oka strain) live attenuated vaccine Inj 19,400 PFU vial with a prefilled diluent syringe Zostavax 1 $0.00 $152.40
Varicella zoster virus (Oka strain) live attenuated vaccine Inj 19,400 PFU vial with a prefilled diluent syringe Zostavax 10 $0.00 $1524.00

A confidential rebate would apply to Zostavax, reducing the net price to the Funder. Subsidy and delisting protection would apply until 30 June 2021.

Vaccines are distributed differently to most other pharmaceuticals. The method for ordering Zostavax would be the same as other vaccines. Zostavax would be listed “Xpharm” with a $0.00 subsidy. An Xpharm listing means that pharmacies cannot claim subsidy because PHARMAC has made alternative distribution arrangements.

Zostavax would be listed in Section I and Part II of Section H of the Pharmaceutical Schedule with the following eligibility criteria: