There's limited access for the general population, but age limits may be cast aside for rheum patients.
In a boon for immunocompromised patients, the PBAC has recommended Shingrix (GSK) access for immunocompromised patients aged 18 and over.
This is in stark contrast to a tight age limitation for the general (non-Indigenous) population, in which only 70-year-olds are eligible.
The PBAC recommendation would see the varicella zoster virus recombinant vaccine included on the National Immunisation Program for non-Indigenous people aged 70, Aboriginal and Torres Strait Islander peoples aged 50 or older and immunocompromised people aged 18 and older with conditions at ‘high risk’ of herpes zoster infection.
Details about the eligible immunocompromised population are yet to be determined, in consultation with ATAGI.
ATAGI has previously recommended Shingrix be given to people with immunocompromise for whom the NIP-listed Zostavax live vaccine is not suitable, although patients were liable for the costs. This includes people currently taking mycophenolate, TNF inhibitors and other bDMARDS (such as anakinra, tocilizumab, abatacept and rituximab), and JAK inhibitors.
PBAC has deferred a decision to potentially include a broader population of immunocompromised people for whom the vaccine would be cost effective, pending ATAGI advice.
GSK’s request to include all (non-Indigenous) adults aged 65, with a catch-up program for adults over 65, was not recommended for those aged 65-69 and 71 or older. PBAC considered they were a lower clinical priority and represented a large number of people, with consequent uncertainty about the cost-effectiveness of Shingrix in these populations being too high.
“It is encouraging that those 70 years of age, indigenous people 50 years and older and those >18 years old at high risk of HZ look like they will receive Shingrix on the PBS,” said Associate Professor Peter Wong, senior staff specialist and head of the rheumatology department at Westmead Hospital, Sydney.
“These are people who clearly need such an effective vaccine to reduce the severe morbidity and even mortality from HZ. However, the risk of HZ is also high in our other immunosuppressed patients who do not fit these categories, especially in those older than 50 years.
“It’s crucial that this other group of patients also have equitable access to Shingrix and the ARA is currently in discussion with ATAGI about the importance of broadening access to Shingrix for those who need it.”
For more March 2023 PBAC outcomes of note for rheumatologists, including the second anifrolumab application and some new listings for psoriasis, see Anifrolumab decision headlines PBAC outcomes.
The full list of March 2023 PBAC outcomes is available on the PBAC website.
