23 November 2019 - The decision not to make zoster vaccination available to people older than 79 years1 was based on cost-efficiency calculations.

But because the loss of efficacy of the vaccine with age is balanced by the greater risk, severity, sequelae, and cost of management of shingles, these calculations might not have been appropriate; if so, is the health of older people being compromised by them, and how can this compromise be ameliorated?

The cost-efficiency analysis of Zostavax (Merck) used standard health-adjusted life-years (HALYs), disability-adjusted life-years (DALYs), and quality-adjusted life years (QALYs), and so have studies of Shingrix (GlaxoSmithKline), the new recombinant vaccine. These analyses are all time based (eg, using years of disease freedom or gained quality of life)—and that is the problem, because a year of disease-free life is not the same for a young adult with 50 statistical years left as it is for an octogenarian with just 5 years left.

Read The Lancet article