Vaccination Against Shingles And Prevention Of Long-Term Ocular Morbidity—A Retrospective Study Of Cost Implications To The National Health Service Of The Uk

The aim of this study was to determine the total costs incurred to the National Health Service (NHS) from patients presenting to hospital eye services with Herpes Zoster Ophthalmicus (HZO), over the age of 50 years, but below the age eligible for vaccination against shingles on the NHS. This study was conducted over a period of 27 months. The costs to hospital services from the attendance and treatment of these shingles patients was determined and from this extrapolated the number of patients that could have been vaccinated, thereby preventing shingles, for the same costs.

A public sector shingles vaccination program was introduced in the UK in 2013 offering vaccination to those over 70 years; the vaccine used was Zostavax as a single dose. From 1st September 2023, the age for vaccination was reduced to 65 years. Zostavax has been superseded by the Shingrix vaccine, given as two separate doses. Shingrix is, however, available to those aged over 50 years in the UK private sector. The study was undertaken at Queen's Hospital, a regional teaching hospital.

We undertook a retrospective study determining the number of patients aged 50-69 years who had attended our hospital with HZO from 1^st April 2022 to 31^st August 2023, and aged 50-65 years from 1^st September 2023 till 31^st July 2024.  We determined how many were affected with long term ocular sequelae of infection with this virus and the subsequent costs to the NHS of multiple attendances to casualty/clinics during the course of their treatment. The costs tallied further included the outpatient/inpatient attendances and the investigative costs (e.g. optical coherence tomography) but excluded the pharmaceutical costs.

Our study shows that during this 27-month period, we had a total of 48 cases of HZO, with 9 patients (18.8%, approximately 1 in 5) going on to develop long term ocular complications requiring hospital attendance and hence long-term care; of these, 44.4% of patients had long-term corneal associated pathology. The total cost of treatment to the NHS of these 48 cases at our hospital was £41,671. We compare the UK vaccination program with those of other countries around the world to discuss the cost/benefit ratio of vaccination against this disease at a younger age.

We concluded that for the cost of treatment of these 48 patients by hospital eye services, and accounting for the previous and current costs of the vaccine, a total of 340 patients could have been vaccinated against shingles (seven times the number of affected patients). Not only is this number significantly more than the number of patients afflicted by shingles in our study, but long-term ocular comorbidity could have been avoided reducing the burden on hospital eye services. This does not account for the costs to patients from time off work and travel costs to the hospital, to name a few. Although further study is required, it appears advisable in terms of cost benefit ratio, to reduce the age of vaccination against shingles to 50 years.