Abstract
Objectives
The US Advisory Committee on Immunization Practices has recently recommended a new vaccine against herpes zoster (shingles) for routine use in adults aged ≥60 years. However, estimates of the cost effectiveness of this vaccine vary widely, in part because of gaps in the data on the value of preventing herpes zoster. Our aims were to (i) generate comprehensive information on the value of preventing a range of outcomes of herpes zoster; (ii) compare these values among community members and patients with shingles and post-herpetic neuralgia (PHN); and (iii) identify clinical and demographic characteristics that explain the variation in these values.
Methods
Community members drawn from a nationally representative survey research panel (n = 527) completed an Internet-based survey using time trade-off and willingness-to-pay questions to value a series of scenarios that described cases of herpes zoster with varying pain intensities (on a scale of 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain) and duration (30 days to 1 year). Patients with shingles (n = 382) or PHN (n = 137) [defined as having symptoms for =90 days] from two large healthcare systems completed telephone interviews with similar questions to the Internet-based survey and also answered questions about their current experience with herpes zoster. We constructed generalized linear mixed models to evaluate the associations between demographic and clinical characteristics, the length and intensity of the health states and time trade-off and willingness-to-pay values.
Results
In time trade-off questions, community members offered a mean of 89 (95% CI 24, 182) discounted days to avoid the least severe scenario (pain level of 3 for 1 month) and a mean of 162 (95% CI 88, 259) discounted days to avoid the most severe scenario (pain level of 8 for 12 months). Compared with patients with shingles, community members traded more days to avoid low-severity scenarios but similar numbers of days to avoid high-severity scenarios. Compared with patients with PHN, community members traded fewer days to avoid high-severity scenarios. In multivariate analyses, older age was the only characteristic significantly associated with higher time trade-off values.
In willingness-to-pay questions, community members offered a mean of $US450 (95% CI 203, 893) to avoid pain of level 3 for 1 month and a mean of $US1384 (95% CI 873, 2050) [year 2005 values] to avoid pain of level 8 for 12 months. Community members traded less money than patients with either shingles or PHN to avoid both low- and high-severity scenarios (p-values <0.05 to <0.001). In multivariate models, male gender, higher income and having experienced shingles or PHN were associated with higher willingness to pay to avoid herpes zoster.
When patients were asked to assign a value to avoiding their own case of herpes zoster, those with shingles assigned a mean of 67 days or $US2319, while those with PHN assigned a mean of 206 days or $US18 184. Both the time and monetary value traded were associated with the maximum intensity of the pain the individual had experienced, but neither was associated with the duration of the pain.
Conclusions
We believe that this study provides the most comprehensive information to date on the value individuals place on preventing herpes zoster, and it includes the only such valuation from nationally representative community members as well as patients with herpes zoster. Community members would trade substantial amounts of time or money to avoid herpes zoster, even in the least severe scenarios. The time trade-off results in this study may differ from those in other studies because of important differences in methods of assessing health utilities. Consideration of both community and patient perspectives is crucial to help decision makers fully determine the implications of their policies now that a vaccine against herpes zoster is available.
Similar content being viewed by others
References
ACIP provisional recommendations for the use of zoster vaccine. 2006 Nov 20. CDC [online]. Available from URL: http://www.cdc.gov/vaccines/recs/provisional/downloads/zoster-ll-2006.pdf [Accessed 2007 Feb 21]
Messonnier ML, Zhou F. Review of economic studies of varicella zoster vaccine [oral presentation]. Advisory Committee on Immunization Practices; 2006 Oct 25; Atlanta (GA)
Hornberger J, Robertas K. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006; 145 (5): 317–25
Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Clin Infect Dis 2007; 44 (10): 1280–8
Pellissier J. Evaluation of zoster vaccine cost-effectiveness. Advisory Committee on Immunization Practices; 2006 Jun 30; Atlanta (GA)
Ortega-Sanchez I. Projected cost-effectiveness of vaccinating the elderly to prevent shingles [oral presentation]. Advisory Committee on Immunization Practices; 2006 Jun 30; Atlanta (GA)
Bala MV, Wood LL, Zarkin GA, et al. Valuing outcomes in health care: a comparison of willingness to pay and quality-adjusted life-years. J Clin Epidemiol 1998; 51 (8): 667–76
Coplan PM, Schmader K, Nikas A, et al. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain 2004; 5 (6): 344–56
Oster G, Harding G, Dukes E, et al. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain 2005; 6 (6): 356–63
van Seventer R, Sadosky A, Lucero M, et al. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. Age Ageing 2006; 35 (2): 132–7
Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
Dennis JM, Chatt C, Li R, et al. Data collection mode effects controlling for sample origins in a panel survey: telephone versus internet. 2005 Jan. Knowledge Networks [online]. Available from URL: http://www.knowledgenetworks.com/ganp/docs/research0105.pdf [Accessed 2007 Dec 06]
Social Security Online. Period life table [online]. Available from URL: http://www.socialsecurity.gov/oact/stats/table4c6.html [Accessed 2005 Oct 4]
Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352 (22): 2271–84
Feeny D, Furlong W, Torrance GW, et al. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care 2002; 40 (2): 113–28
Feeny DH, Torrance GW, Furlong WJ. Health utilities index. In: Spilker B, editor. Quality of life pharmacoeconomics in clinical trials. 2nd ed. Philadelphia (PA): Lippincott-Raven Publishers, 1996: 239–51
Lipscomb J, Weinstein MC, Torrance GW. Time preference. In: Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996: 214–35
Gouskova E, Stafford F. Trends in household wealth dynamics, 1999–2001. Ann Arbor (MI): Institute for Social Research, University of Michigan, 2002 Sep 30. Panel study on income dynamics [online]. Available from URL: http://psidonline.isr.umich.edu/publications/papers/trendsindynamicsl999–2001.pdf [Accessed 2007 Dec 06]
Efron B, Tibshirani R. An introduction to the bootstrap. New York: Chapman & Hall, 1993
Prosser LA, Ray GT, O’Brien M, et al. Preferences and willingness to pay for health states prevented by pneumococcal conjugate vaccine. Pediatrics 2004; 113 (2): 283–90
Ubel PA, Loewenstein G, Jepson C. Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Qual Life Res 2003; 12 (6): 599–607
Baron J, Asch DA, Fagerlin A, et al. Effect of assessment method on the discrepancy between judgments of health disorders people have and do not have: a web study. Med Decis Making 2003; 23 (5): 422–34
Kahneman D, Fredrickson BL, Schreiber CA, et al. When more pain is preferred to less: adding a better end. Psychol Sci 1993; 4 (6): 401–5
Krosnick JA, LinChiat C. A comparison of the random digit dialing telephone survey methodology as implemented by Knowledge Networks and Harris Interactive. Conference of the American Association for Public Opinion Research; 2001 May 17–20; Montreal (QC)
Lenert LA. The reliability and internal consistency of an internet-capable computer program for measuring utilities. Qual Life Res 2000; 9 (7): 811–7
Swan JS, Sainfort F, Lawrence WF, et al. Process utility for imaging in cerebrovascular disease. Acad Radiol 2003; 10 (3): 266–74
Swan JS, Lawrence WF, Roy J. Process utility in breast biopsy. Med Decis Making 2006; 26 (4): 347–59
Mortimer D. The value of thinly spread QALYs. Pharmacoeconomics 2006; 24 (9): 845–53
Acknowledgements
This study was supported by the Joint Initiative in Vaccine Economics Project of the Centers for Disease Control and Prevention. The authors have no conflicts of interest that are directly relevant to the contents of this study.
The findings and conclusions expressed are those of the authors and do not necessarily represent the view of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
We are grateful to Michael Oxman, MD, for advice on descriptions of herpes zoster health states. We thank Amethyst Leimpeter, Keeli McClearnen and Kathleen Albers for their invaluable support in the recruitment of patients from Northern California Kaiser Permanente. We appreciate the thoughtful efforts of our Harvard-based research assistants Elizabeth R. Suda, Patti Steele, Leigh Evans and Wan-Ju Wu. We are very grateful to our consultants Mark Messonnier, PhD, Phaedra Corso, PhD and Eve Wittenberg, PhD, for expert advice on methods of analysis.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Lieu, T.A., Ortega-Sanchez, I., Ray, G.T. et al. Community and Patient Values for Preventing Herpes Zoster. Pharmacoeconomics 26, 235–249 (2008). https://doi.org/10.2165/00019053-200826030-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200826030-00006