Does spending $14,000 to prevent one case of shingles over three years represent \u201cvalue for money\u201d?<\/p>\n
A commentary by Alan Cassels, a \u00addrug-policy researcher and author in \u00adVictoria.<\/p>\n
This week, the NDP pledged to strengthen health care for B.C. seniors, promising more support at home, more help to stay healthy and out of hospital and more long-term care beds. Who could be against that?<\/p>\n
However, NDP Leader David Eby, thick in a boisterous election campaign and running a government with debt up to the eyeballs, didn\u2019t bother costing out these health-care promises.<\/p>\n
For example, he mentioned that if elected, the NDP would provide \u201cfree\u201d shingles vaccine for everyone over 50.<\/p>\n
Last time I checked, vaccines aren\u2019t \u201cfree.\u201d Someone pays for them. The money comes from the patients\u2019 pockets or the government\u2019s coffers.<\/p>\n
The real question is, is it worth it?<\/p>\n
Shingles typically involves tingling, burning, itching or severe pain along a single nerve pathway, sometimes with a blistering rash that typically heals over in two to four weeks; useful \u2014 and cheap \u2014 antiviral medications can speed recovery. More serious is when shingles develops into long-term nerve pain called postherpetic neuralgia (PHN), which is thankfully very rare.<\/p>\n
Analyzing the randomized trials of the major shingles vaccines provides a unique case study for determining how cost-effective Eby\u2019s promise is. We all expect governments to pay for health care that is good value for money. Boomers like myself abhor wasteful spending of all kinds, so let\u2019s look at the numbers around the shingles vaccine:<\/p>\n
0.3 per cent to 1 per cent: Per-year chance of a B.C. person over 50 getting shingles. Basically, the likelihood you won\u2019t catch shingles every year is over 99 per cent. The chance of getting shingles increases slightly as you get older, but not by much.<\/p>\n
32: Number of people over 50 who need to get vaccinated with the standard shingles vaccine to prevent one shingles case (over three years). This is called NNV or Number Needed to Vaccinate. In other words, the vaccine doesn\u2019t work for 31 out of 32 people who are vaccinated.<\/p>\n
333: Number of people over 50 who need to get vaccinated with the standard shingles vaccine to prevent one case of postherpetic neuralgia (over three years).<\/p>\n
11 to 25: Number of people over 50 who get the vaccine who end up with one case of systemic reaction (effects include fatigue, weakness, headache, shivering and stomach problems). This is called NNH, or Number Needed to Harm.<\/p>\n
In other words, between one in 11 and one in 25 people vaccinated will experience these side-effects and possibly be out of action for several days.<\/p>\n
$430: Cost of the two-dose shingles vaccine (Shingrix) from a Victoria pharmacy.<\/p>\n
$13,760: Total cost of the shingles vaccine to prevent one case of shingles in people over 50 (over three years). 32 times $430.<\/p>\n
$143,190: Total cost of the shingles vaccine to prevent one case of PHN in people over 50 (over three years). 333 times $430.<\/p>\n
2.2 million: Number of B.C. citizens over 50 (about 38% of B.C.\u2019s population)<\/p>\n
$946 million: The cost of vaccinating every British Columbian over 50 with the shingles vaccine.<\/p>\n
I hope you follow my math. This \u201cfree\u201d shingles vaccine would cost the government almost a billion dollars if everyone got it. Remember, this is a disease that 99 per cent of the population will never get in any given year, where bothersome vaccine side effects are much more likely than any of shingles\u2019 rare complications.<\/p>\n
Does spending $14,000 to prevent one case of shingles over three years represent \u201cvalue for money\u201d?<\/p>\n
The unlucky 1 per cent who get shingles can still be treated with $70 worth of antivirals.<\/p>\n
Can our health system better use that $14,000, instead of shipping it to a vaccine manufacturer? A vaccine that doesn\u2019t help 31 out of 32 people thus vaccinated seems extremely low yield.<\/p>\n
At the end of the day, voters will determine if Eby\u2019s \u201cfree\u201d shingles shots is a cost-effective promise.<\/p>\n
I am all for helping seniors, but to bribe the electorate with a low-yield and pricey shot that carries hardly any health impact makes little financial sense to me.<\/p>\n