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Considering the severity of pain associated with herpes zoster, or shingles, the introduction of a vaccine for the condition would seem like a minor miracle, yet few patients have received the vaccine in the nearly two years that it's been available, and few dermatologists are even offering it.
Only 1.9 percent of people over age 60 have actually had the vaccine - Merck's Zostavax - according to the National Immunization Survey from the Centers for Disease Control and Prevention. The main reason, according to 48 percent of 843 respondents, was that they felt it was not needed. The next most common reason, according to 13 percent of respondents, was that they simply didn't know about the vaccine.
According to Merck, Zostavax is sold at a catalog price of $153.93 per dose when purchased as part of a 10-pack, or $161.50 when purchased as a single dose. Furthermore, says spokeswoman Deb Wambold, more than 90 percent of people in private health plans are in plans that reimburse for Zostavax.
But Dr. Brodell says the key issue is not whether the vaccine is covered, but the amount of the price that is reimbursed.
"One insurer may cover much of the vaccine, but another may only reimburse a small fraction of the cost, and if the physician provides the vaccine and the patient later finds out they are liable for most of the cost, they will be angry, they may not pay, and you're stuck with the loss," he says.
The Medicare coverage is also confusing for some - while the influenza and PPV vaccines are covered under Medicare Part B, the zoster vaccine's administration and costs are under Part D, which fewer Medicare beneficiaries have.
Comparatively, rates of compliance in the over-65 age group with the influenza vaccine are significantly higher, at 69 percent, according to the U.S. Centers for Disease Control and Prevention, and the much lower cost of those vaccines likely explains that high rate, Dr. Brodell says.
"If the cost (of the zoster vaccine) was much lower, a physician could load up on the vaccine and feel confident that they wouldn't expose themselves to potentially big losses," he says.
Jeffrey Weinberg, M.D., agrees that insurance uncertainties are proving a big deterrent for many dermatologists who might otherwise hop on the Zostavax bandwagon.
"There is a lot of confusion," says Dr. Weinberg, director of clinical research, dermatology department, St. Luke's-Roosevelt Hospital Center, New York. "I think some dermatologists will pick it up - particularly those with elderly patients - but the majority of them won't."
Dr. Weinberg is in the minority of dermatologists who do offer the vaccine.
"I've seen what shingles patients can go through, so it's sort of a no-brainer," he says. "It's eminently safe, and if you can give it to patients and make people aware, it's really worthwhile."