| Description |
In 2013, results from the National Health Interview Survey (NHIS) reported that approximately 24% of US adults aged 60+ had been vaccinated with the herpes zoster (HZ) vaccine. This compares to nearly 60% for pneumococcal vaccination, which suggests that barriers to HZ vaccination may exist in older adults. Cost and access have been identified as some of the most salient barriers to vaccination. The objective of this dissertation was to examine the effect that cost-sharing and access to the vaccine have on HZ vaccination rates. Vaccination rates were examined according to demographic and clinical characteristics for adults aged 60+ in the Utah All Payers Claims Database (APCD). Moreover, cost-sharing was examined in adults aged 60+ stratified by age group. Access as a barrier was examined using the 2014 Behavioral Risk Factor Surveillance System (BRFSS) dataset. A law review was performed to define exposure groups: states that required a prescription order (Rx Restricted) and states that did not require a prescription order (Allowed). Covariate adjustment, propensity score methods, and multilevel models were employed. Of the 456,438 adults with a claim in the APCD, 30,293 had documentation of HZ vaccination. HZ vaccination documentation was associated with older age, marital status, race, education, and select medical/pharmacy claims. The median cost-sharing across all individuals with a HZ vaccine claim was $8.55 (min: $0; max: $440). For adults aged 60-64, the median cost-sharing was $0; for adults iv aged 65+, the median cost-sharing was $85. The odds of having any cost-sharing for adults aged 65+ was 39.9 as compared to adults aged 60-64. Thirty-nine states allowed pharmacists to administer HZ without a patient-specific prescription order. The HZ vaccination rate for Allowed states was 33.7% as compared to 27.4% for Rx Restricted states. The odds of vaccination for adults aged 60+ ranged from 1.12 to 1.35. Providers and health policy makers should encourage patients to be vaccinated before age 65 to avoid the high levels of cost-sharing thereafter. Moreover, Medicare Part D plans should consider reducing the cost-sharing burden. States should consider the removal of the prescription order requirement to promote HZ vaccination. |
