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Factors Associated with Zostavax Abandonment

This study highlights the implications of noncompliance with the use of in-network providers for immunization services, shedding light on value-based benefits design to promote access to recommended vaccinations.
 
Published Online: Aug 18,2016
Osayi E. Akinbosoye, PhD, PAHM; Michael S. Taitel, PhD; James Grana, PhD; and Catherine Macpherson, MS, RD
ABSTRACT
Objectives: To determine patient and health plan factors associated with Zostavax abandonment, and to assess the responsiveness of Zostavax abandonment rates to patient out-of-pocket costs, among a community pharmacy’s patients aged 50 years and older.
Study Design: Descriptive statistical analysis and econometric modeling of retrospective pharmacy claims data. 
Methods: The study utilized data for patients who requested a prescription fill for a Zostavax vaccine at the community pharmacy in October 2014. The vaccine was considered abandoned if there was no evidence of it being administered to the patient within 30 days of the fill date. The outcome of interest was abandonment rate, calculated as the proportion of patients within a particular group of interest who abandoned the vaccine. 
Results: During the study period, a total of 172,977 fills for Zostavax were initiated, and a total of 67,369 were abandoned; overall abandonment rate was 38.9%. Abandonment rate varied by patient demographics and health plan factors, but patient out-of-pocket cost (OOP) remained the most significant predictor of abandonment, after adjusting for other factors. While the odds of abandonment were 1.66 times higher for patients with OOP in the $15-$34 range compared with those with OOP ≤$14.99, odds were much higher—at 5.53 times—for those with OOP in the $105-$174.99 range. 
Conclusions: Our study highlights the implications of patients’ noncompliance with the use of in-network providers for immunization services and could be leveraged for value-based benefits design to promote access to recommended vaccinations.
Am J Pharm Benefits. 2016;8(4):84-89
 
According to the CDC, almost 1 in 3 people in the United States will develop shingles during their lifetime.1 Zostavax is a vaccine approved to prevent shingles in adults aged 50 years and older. The vaccine may be administered by a physician, or by other licensed healthcare professionals, including pharmacists, where allowed by state law.

Although approved by the FDA in 2011 for adults aged 50 to 59 years,2 the Advisory Committee on Immunization Practices (ACIP) recommends Zostavax for adults aged 60 years and older.3 A large clinical trial that tested Zostavax versus placebo in 38,000 adults aged 60 years and older found Zostavax effective in reducing the overall incidence of shingles by about 51% and the incidence of post herpetic neuralgia by 67%.4 Yet, the CDC reports that only 24.2% of adults aged 60 years and older received the vaccine in 2013.5 Although this is an increase from previous years (eg, 20.1% in 2012), we still need to better understand the barriers to getting the shingles vaccine.




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