Jerry Buttimer (Cork South-Central, Fine Gael)

I thank Deputy Burke for raising this matter in the House this evening. I am taking the matter on behalf of the Minister for Health, who shares Deputy Burke's concerns in relation to the current cost of shingles vaccination in Ireland. Varicella is a common, highly infectious disease caused by the varicella zoster virus. The virus is associated with two distinct clinical syndromes, varicella, known as chickenpox, and herpes zoster, commonly known as shingles. Primary infection with the varicella zoster virus results in varicella, after which the virus becomes latent in the body’s nervous system. The virus may reactivate after a period, sometimes several decades later, resulting in herpes zoster or shingles. Approximately one third of people who have had a varicella infection will develop a shingles infection at some point during their lifetime due to reactivation of the virus.

Morbidity associated with herpes zoster increases with age. The most common complication is post-herpetic neuralgia, a persistent pain in the area of the rash. This has the potential to cause significant reductions in quality of life, activity, mood and sleep. Two thirds of cases occur in those aged 50 and older. The risk of developing the disease in those aged 85 and over is 50%. A non-live, recombinant shingles vaccine called Shingrix is available in Ireland and is given as a two-dose vaccine. Shingrix is more effective than the previously available live vaccine Zostavax and can be safely administered to immunocompromised patients. Shingrix has also replaced Zostavax as the preferred vaccine against shingles internationally. The national immunisation advisory committee guidelines state that the Shingrix vaccine may be considered in those aged 65 and older due to the greater burden and severity of disease and post-herpetic neuralgia in this age group and in those aged 18 years and older at increased risk of shingles. The shingles vaccine is not currently provided as part of the national immunisation programme.

The Minister for Health advises that following a request from her Department, HIQA carried out a health technology assessment, HTA, on the herpes zoster vaccine which protects against shingles. This assessment examined the evidence on the clinical effectiveness and safety of shingles vaccines. The cost-effectiveness and budget impact were also reviewed, along with the ethical, social and organisational implications of including the vaccine in the adult immunisation schedule. HIQA published this HTA on 19 July last year. The HTA found that adding the shingles vaccine to the routine immunisation schedule at the vaccine price at the time for all adults aged 65 and over would not be cost-effective and would be associated with a substantial budget impact. While the HTA found that the introduction of the shingles vaccine was not cost-effective based on the cost of the vaccine, it found that it could be cost-effective for vaccination of those aged 75 years and 80 years if the cost of the vaccine was reduced by 80%. Given that the healthcare budget is finite and decisions regarding increased spending relating to a change in one area could impact the provision of other health technologies and treatments within the healthcare system, the cost-effectiveness must be considered in any decision-making process. The Department considered the findings of this HTA and determined that the introduction of the vaccine could be reconsidered when the cost-effectiveness of the vaccine is confirmed as more favourable.

On the question of the shingles vaccine being included in the drugs payment scheme and the medical card scheme, it is the Health Service Executive which has statutory responsibility for decisions on pricing and reimbursement of medicines in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The Minister for Health has no role in decisions relating to approving which medical products are covered under these schemes.

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