Abstract
BACKGROUND:
Despite broad recommendations in older adults, uptake for the 2-dose recombinant zoster vaccine (RZV), which protects against herpes zoster (ie, shingles), has historically been low in the United States among those aged 50 years and older. By recommending RZV, health care providers play a critical role in encouraging shingles prevention among older adults. A vaccine prescription may reinforce a recommendation, but understanding the extent and associated characteristics of uptake following prescription is needed.
OBJECTIVE:
To describe RZV uptake following an RZV prescription among US adults aged 50 years and older.
METHODS:
RZV uptake following a prescription among adults aged 50 years and older in the United States was assessed from 2017 to 2023 using administrative claims data linked with electronic health records. Patient demographic and clinical characteristics, provider characteristics, and health system factors were presented descriptively and compared between those with and without RZV administration following a prescription. A Cox proportional hazards model assessed associations between patient, provider, and health system factors and RZV administration following an RZV prescription.
RESULTS:
Of the 8,715 patients with an RZV prescription included, vaccine uptake following prescription was generally high: 71% of patients received at least 1 RZV dose following prescription, of which 82% were administered in a pharmacy setting. Among prescriptions with a known provider specialty source, 91% were written by primary care physicians or internal medicine providers. Factors such as Medicare Advantage with Part D coverage (vs commercial insurance), household income of at least $75,000 (vs <$40,000), and having an immunocompromising or autoimmune condition were associated with higher rates of RZV administration following a prescription.
CONCLUSIONS:
Receipt of RZV is likely following a healthcare provider’s recommendation, as shown by the high uptake observed among adults who received RZV prescriptions in this study. Additional efforts are needed to ensure full adherence with provider recommendations for herpes zoster prevention.
Plain language summary
Although a prescription may not be needed to get the herpes zoster vaccine, healthcare providers may provide one to support a recommendation. This study observed that most people (71%) who got a herpes zoster vaccine prescription were ultimately vaccinated. Most people who got the vaccine (82%) did so at a pharmacy, and those adults receiving Medicare, with higher incomes, or with health conditions affecting immune system functioning were more likely to get vaccinated.
Implications for managed care pharmacy
Even with existing recommendations, recombinant zoster vaccine (RZV) uptake is relatively low. Despite the high overall uptake of RZV following prescription, observed delays and gaps in vaccination among certain segments of the population underscore opportunities for pharmacists to proactively reinforce the existing recommendation. With most RZV doses administered in community pharmacies, prescriptions may serve as a valuable prompt for pharmacists to encourage timely vaccination and address unmet needs.
The 2-dose recombinant zoster vaccine (RZV) is recommended to protect against herpes zoster (HZ) (ie, shingles) in the United States for all adults aged 50 years and older,1 as well as for adults aged 19 years and older with a weakened immune system due to immunodeficiency or immunosuppression caused by known disease or therapy.2 Despite broad recommendations in older adults, the Centers for Disease Control and Prevention (CDC) have estimated that, as of 2022, uptake of RZV in US adults aged 50 years and older was only 25.6% for at least 1 dose and 18.1% for at least 2 doses.3 Significant differences in uptake by social determinants of health (SDoH) have also been observed. For example, significantly lower uptake and likelihood of HZ vaccination have been estimated among Black and Hispanic adults relative to non-Hispanic White adults aged 50 years and older.3,4
A patient’s decision to be vaccinated and receive RZV may be shaped by healthcare providers (HCPs), who play a notable role in recommending and/or prescribing vaccines.5 Although RZV is often administered in community pharmacies outside the provider office setting,6 physicians remain integral in ensuring patients receive their recommended vaccines. HCPs are encouraged by the CDC’s Standards for Adult Immunization Practice to assess the immunization status of their patients at every clinical encounter, enabling them to facilitate vaccination for their patients.7 Furthermore, patient preference surveys indicate greater likelihood of accepting vaccination after an HCP recommendation.8,9
A prescription, although not required for RZV in adults aged 50 years and older in the United States, represents a documented HCP recommendation for vaccination and may facilitate bridging an HCP recommendation to subsequent vaccine administration in a pharmacy setting. However, there is a lack of evidence regarding the usage of vaccine prescriptions, and greater understanding of the extent of uptake following prescription is needed.
Methods
STUDY DESIGN
This was a retrospective cohort study of administrative claims data linked with electronic health records (EHRs) from November 1, 2016, through March 31, 2023, including adults aged 50 years and older in the United States who were either commercial or Medicare Advantage with Part D (MAPD) health plan members.
Eligible patients were aged 50 years and older as of the index year (year of first date of RZV prescription from EHR data), continuously enrolled with medical and pharmacy benefits for at least 12 months prior to index (administrative gaps of ≤32 days were permitted between enrollment periods and enrollment periods were bridged over these gaps), and had at least 1 RZV prescription from the integrated EHR data during the patient identification period (November 1, 2017, to March 31, 2023).10 Patients were excluded if they had an RZV prescription before the index date (earliest date of RZV prescription during the patient identification period), including the 12-month baseline period, evidence of RZV administration before the first RZV prescription, or unknown demographic information (Figure 1).
FIGURE 1.
Observation Period
EHR = electronic health record; RZV = recombinant zoster vaccine.
Included patients were followed until the end of the study period, disenrollment from the health plan, or death. Death was included as a censoring event in the follow-up period, with the last date of medical or pharmacy service during the month of death used as the date of death. If the last date of service was not available, the last day of the month of death was used as the date of death.
STUDY DATA
The Optum Research Database (ORD) is a deidentified research database of commercial and Medicare Advantage claims, containing both medical and pharmacy information. Medical claims are collected from all available healthcare sites for virtually all types of provided services. Claims for pharmacy services are typically submitted electronically by the pharmacy at the time prescriptions are filled. Individual-level data can be linked to the administrative claims data in the ORD, allowing for socioeconomic characteristics to be derived and analyzed. The data populating these socioeconomic elements are generated by a combination of modeling, census data, and a variety of other individual-level and population-level data sources.
Optum’s Clinical EHR Database aggregates longitudinal, Health Insurance Portability and Accountability Act (HIPAA) of 1996–compliant, and statistically deidentified clinical encounter data. Data elements include demographics, medications prescribed and administered, immunizations, allergies, laboratory results (including microbiology), vital signs and other observable measurements, clinical and inpatient stay administrative data, and coded diagnoses and procedures (Supplementary Table 1 (375.8KB, pdf) , available in online article). Variable choices included in the study were determined based on data availability, with values determined in the baseline period or as of the index date (Supplementary Table 2 (375.8KB, pdf) ).
OUTCOMES
The provider specialty for RZV prescription was recorded, and a binary variable indicated whether the prescription was received during a wellness/preventive care visit. RZV coprescription with at least 1 other vaccine (influenza, pneumococcal, or tetanus and diphtheria or tetanus, diphtheria, and pertussis [Td/Tdap]) on the index date was also captured.
RZV administration following prescription (on or after the index date) was captured, along with RZV administration location (healthcare setting in which the vaccine was administered) and whether RZV was coadministered with another vaccine. If multiple RZV prescriptions or administrations were recorded, the earliest was retained. Latency between RZV prescription and administration was captured, defined as the time (in days) between the index RZV prescription and the first RZV administration.
ANALYSIS
Patient demographic and clinical characteristics, provider characteristics, and health system factors were presented descriptively and compared between those with and without RZV administration following RZV prescription. Continuous measures were reported as mean (SD) or median (interquartile range [IQR]); categorical measures were reported as count (number) and percentage. The censor-adjusted proportion of patients remaining unvaccinated after receipt of RZV prescription at varying time points was evaluated via a Kaplan-Meier analysis.
Associations between patient, provider, and health system factors and the rate of RZV administration following RZV prescription were assessed with a Cox proportional hazards model. Results were presented as hazard ratios with 95% CIs and P values for each covariate included in the final model. Statistical analyses were conducted using SAS 9.4 (SAS Institute Inc.). As this study used deidentified data, informed consent, ethics committee, and institutional review board approval were not required.
Results
OVERALL POPULATION CHARACTERISTICS
From the available patient records (N = 662,939), 1.8% of patients (n = 11,804) had an RZV prescription during the identification period and 8,715 met criteria for inclusion in the present analysis (Supplementary Figure 1 (375.8KB, pdf) ). Of those who were included, 15.4% had at least 1 other RZV prescription after their initial prescription.
For all included patients, mean (SD) age was 70.1 (9.1) years, and most were female (58.0%) and non-Hispanic White (78.8%). Most patients resided in urban areas (95.6%), and the majority resided in the Midwest (44.9%) or the South (25.1%). Mean (SD) baseline Charlson Comorbidity Index (CCI) score was 0.9 (1.5), and 45.5% of patients had an immunocompromising or autoimmune condition (Table 1). More patients had MAPD insurance plan than commercial insurance (71.6% vs 28.4%) (Supplementary Table 3 (375.8KB, pdf) ).
TABLE 1.
Demographic and Clinical Characteristics for Those With And Without RZV Administration Following RZV Prescription
| Characteristic | All patients (N = 8,715) | RZV administration following prescription (n = 6,192) | No RZV administration following prescription (n = 2,523) | P valuea |
|---|---|---|---|---|
| Age, years | ||||
| Mean (SD) | 70.1 (9.1) | 70.1 (8.9) | 70.2 (9.6) | 0.499 |
| Median (Q1, Q3) | 71.0 (64.0, 76.0) | 71.0 (64.0, 76.0) | 71.0 (62.0, 77.0) | – |
| Age group, n (%) | ||||
| 50–59 years | 1,304 (15.0) | 887 (14.3) | 417 (16.5) | 0.009 |
| 60–64 years | 1,030 (11.8) | 680 (11.0) | 350 (13.9) | <0.001 |
| 65–69 years | 1,495 (17.2) | 1,154 (18.6) | 341 (13.5) | <0.001 |
| 70–79 years | 3,477 (39.9) | 2,539 (41.0) | 938 (37.2) | <0.001 |
| 80+ years | 1,409 (16.2) | 932 (15.1) | 477 (18.9) | <0.001 |
| Sex, n (%) | ||||
| Female | 5,056 (58.0) | 3,614 (58.4) | 1,442 (57.2) | 0.299 |
| Male | 3,659 (42.0) | 2,578 (41.6) | 1,081 (42.9) | 0.299 |
| Race and ethnicity, n (%) | ||||
| Non-Hispanic White | 6,866 (78.8) | 4,988 (80.6) | 1,878 (74.4) | <0.001 |
| Non-Hispanic African American/Black | 823 (9.4) | 518 (8.4) | 305 (12.1) | <0.001 |
| Non-Hispanic Asian | 264 (3.0) | 190 (3.1) | 74 (2.9) | 0.738 |
| Hispanic | 545 (6.3) | 335 (5.4) | 210 (8.3) | <0.001 |
| Unknown/Other | 217 (2.5) | 161 (2.6) | 56 (2.2) | 0.301 |
| Index year, n (%) | ||||
| 2017b | 15 (0.2) | 10 (0.2) | 5 (0.2) | 0.708 |
| 2018 | 3,572 (41.0) | 2,473 (39.9) | 1,099 (43.6) | 0.002 |
| 2019 | 3,009 (34.5) | 2,118 (34.2) | 891 (35.3) | 0.323 |
| 2020 | 1,399 (16.1) | 1,116 (18.0) | 283 (11.2) | <0.001 |
| 2021 | 449 (5.2) | 297 (4.8) | 152 (6.0) | 0.019 |
| 2022 | 233 (2.7) | 154 (2.5) | 79 (3.13) | 0.019 |
| 2023b | 38 (0.4) | 24 (0.4) | 14 (0.6) | 0.282 |
| Education level, n (%) | ||||
| No high school diploma | 11 (0.1) | 7 (0.1) | 4 (0.2) | 0.587 |
| High school diploma | 2,047 (23.5) | 1,395 (22.5) | 652 (25.8) | <0.001 |
| Some college or associate degree | 4,830 (55.4) | 3,440 (55.6) | 1,390 (55.1) | 0.694 |
| Bachelors/graduate/professional degree | 1,784 (20.5) | 1,312 (21.2) | 472 (18.7) | 0.009 |
| Missing/unknown | 43 (0.5) | 38 (0.6) | 5 (0.2) | 0.012 |
| Household income, n (%) | ||||
| <$40,000 | 1,868 (21.4) | 1,251 (20.2) | 617 (24.5) | <0.001 |
| $40,000–$49,999 | 609 (7.0) | 417 (6.7) | 192 (7.6) | 0.146 |
| $50,000–$59,999 | 731 (8.4) | 511 (8.3) | 220 (8.7) | 0.475 |
| $60,000–$74,999 | 1,084 (12.4) | 757 (12.2) | 327 (13.0) | 0.346 |
| $75,000–$99,999 | 1,583 (18.2) | 1,167 (18.9) | 416 (16.5) | 0.010 |
| $100,000+ | 2,739 (31.4) | 2,014 (32.5) | 725 (28.7) | <0.001 |
| Missing/unknown | 101 (1.2) | 75 (1.2) | 26 (1.0) | 0.475 |
| Urban/rural, n (%) | ||||
| Urban | 8,328 (95.6) | 5,873 (94.9) | 2,455 (97.3) | <0.001 |
| Rural | 386 (4.4) | 318 (5.1) | 68 (2.7) | <0.001 |
| Unknown/missing | 1 (0.0) | 1 (0.0) | 0 (0.0) | 0.523 |
| Region, n (%) | ||||
| Northeast | 1,553 (17.8) | 842 (13.6) | 711 (28.2) | <0.001 |
| Midwest | 3,913 (44.9) | 2,954 (47.7) | 959 (38.0) | <0.001 |
| South | 2,185 (25.1) | 1,633 (26.4) | 552 (21.9) | <0.001 |
| West | 1,064 (12.2) | 763 (12.3) | 301 (11.9) | 0.612 |
| Other | 0 (0.0) | 0 (0.0) | 0 (0.0) | – |
| Baseline Charlson Comorbidity Index26–28, mean (SD) | 0.9 (1.5) | 0.9 (1.4) | 1.0 (1.6) | 0.083 |
| Baseline Charlson Comorbidity Index 28 , n (%) | ||||
| 0 | 5,025 (57.7) | 3,572 (57.7) | 1,453 (57.6) | 0.934 |
| 1–2 | 2,634 (30.2) | 1,897 (30.6) | 737 (29.2) | 0.189 |
| 3–4 | 754 (8.7) | 532 (8.6) | 222 (8.8) | 0.755 |
| 5+ | 302 (3.5) | 191 (3.1) | 111 (4.4) | 0.002 |
| Immunocompromising or autoimmune conditionc, n (%) | 3,966 (45.5) | 2,965 (47.9) | 1,001 (39.7) | <0.001 |
| HZ diagnosis in baseline, n (%) | 206 (2.4) | 150 (2.4) | 56 (2.2) | 0.572 |
| History of ZVL administration, n (%) | 211 (2.4) | 147 (2.4) | 64 (2.5) | 0.654 |
RZV administration vs no RZV administration following prescription P value; 2-sample t-test was used for continuous measures; Pearson chi-square test was used for binary measures.
The study period only included a portion of 2017 (November 01, 2017, to December 31, 2017) and 2023 (January 01, 2023, to March 31, 2023).
Included rheumatoid arthritis, inflammatory bowel disease (Crohn disease and ulcerative colitis), psoriatic arthritis, psoriasis, solid organ or bone marrow transplant, systemic lupus erythematosus, multiple sclerosis, HIV/AIDS, and malignancy (solid, hematologic).
AIDS = acquired immunodeficiency syndrome; HIV = human immunodeficiency virus; HZ = Herpes zoster; Q1 = 25th percentile; Q3 = 75th percentile; RZV = recombinant zoster vaccine; ZVL = Zoster vaccine live.
Provider specialty source was known and specified for 73.4% of RZV prescriptions, and 73.0% were prescribed during a wellness/preventive visit. Among prescriptions with known provider specialty, the majority (91.2%) were written by primary care or internal medicine providers (55.5% and 35.6%, respectively) (Supplementary Table 3 (375.8KB, pdf) ).
UPTAKE OF RZV AFTER PRESCRIPTION
Among those with an RZV prescription, 71.0% were vaccinated with RZV during the variable follow-up period. The majority (82.4%) of RZV doses were administered in a pharmacy, 95.0% of which were retail pharmacies. For those who received RZV administration, the median (Q1-Q3) latency was 14 (0-266) days from prescription to administration. In Kaplan-Meier analysis, the censor-adjusted proportion of patients remaining unvaccinated following RZV prescription was 61.7% at 30 days, 56.0% at 90 days, 41.9% at 360 days, and 19.3% at 1,800 days (Supplementary Figure 2 (375.8KB, pdf) ).
Among those with an RZV prescription, 8.5% were coprescribed other vaccines, including Td/Tdap (45.2%), influenza (38.3%), and/or pneumococcal (25.9%). Of the patients with coprescription, 65.5% were coadministered RZV with 1 or more other vaccines (Supplementary Figure 3 (375.8KB, pdf) ).
CHARACTERISTICS ASSOCIATED WITH RZV ADMINISTRATION
Descriptive Analysis
Individuals who were vaccinated included a significantly higher percentage of non-Hispanic White patients compared with those not administered RZV (80.6% vs 74.4%, P < 0.001) and a significantly lower percentage of non-Hispanic African American/Black (8.4% vs 12.1%, P < 0.001) and Hispanic patients (5.4% vs 8.3%, P < 0.001). A significantly higher proportion of vaccinated patients had a household income above $100,000 (32.5% vs 28.7%, P < 0.001) or had evidence of any immunocompromising or autoimmune condition (47.9% vs 39.7%; P < 0.001) (Table 1).
The proportion of patients with certain Agency for Healthcare Research and Quality Clinical Classifications Software comorbidities (eg, disorders of lipid metabolism, diseases of the urinary system, benign neoplasms, respiratory infections, and upper gastrointestinal disorders) was significantly higher among those with vs without RZV administration (Supplementary Table 4 (375.8KB, pdf) ).
Of those with RZV administration, 65.8% received their prescription during a wellness/preventive care visit, compared with 90.7% of patients without RZV vaccination following prescription (P < 0.001). Additionally, where provider specialty was known, the proportion of patients who obtained their prescription from a primary care provider was higher among those who received RZV (56.9%) vs those who did not (52.7%). There was a significantly lower proportion of patients living in a health professional shortage area11 among those vaccinated vs those without evidence of RZV administration (2.5% vs 3.6%; P = 0.006) (Supplementary Table 3 (375.8KB, pdf) ).
Predictors Of RZV Administration
Factors significantly associated with higher rates of RZV administration following prescription included having MAPD insurance plan (vs commercial insurance), a household income of at least $75,000 (vs <$40,000), having an immunocompromising or autoimmune condition, evidence of certain Agency for Healthcare Research and Quality Clinical Classifications Software comorbidities (immunizations or screening for infectious disease, eye disorders, other skin disorders, and other nutritional, endocrine, and metabolic disorders vs not having such conditions or comorbidities), and residing in non–health professional shortage area areas (all P < 0.001) (Figure 2, Supplementary Table 5 (375.8KB, pdf) ).
FIGURE 2.
Predictors of RZV Administration Following RZV Prescription
Observations read: 8,715; observations used: 8,715.
CCI = Charlson Comorbidity Index; HR = hazard ratio; IC/AID = immunocompromised/autoimmune disorder; MAPD = Medicare Advantage Part D; ref = reference; RZV = recombinant zoster vaccine.
Factors significantly associated with lower rates of RZV administration were being older than age 70 years (vs age 50-59 years), being non-Hispanic Black (vs non-Hispanic White), residing in regions other than the Midwest, and having a baseline CCI score of 1-2 or greater than or equivalent to 5 (vs 0) (all P < 0.05) (Figure 2, Supplementary Table 5 (375.8KB, pdf) ).
The specialty of the provider who wrote the prescription (internal medicine or other specialty vs primary care) was not significantly associated with RZV administration.
Discussion
This study estimated that RZV uptake following prescription was generally high, with 71.0% of patients administered an RZV dose following prescription. Patients with MAPD insurance plan (vs commercial), household income of at least $75,000 (vs <$40,000), and evidence of an immunocompromising or autoimmune condition or certain comorbidities (vs no evidence of these conditions) had a higher likelihood of vaccine uptake following prescription. Vaccine prescriptions may bridge HCP recommendations and pharmacy vaccine administration by encouraging patient follow-through after receiving a vaccine recommendation. Moreover, consideration could be made for combining vaccine prescriptions with other systems-based approaches to address unmet vaccination needs, such as patient and provider nudges, the use of which has been associated with higher odds of HZ vaccine series completion.12,13 Significant delays in vaccination among some patients, or the receipt of multiple RZV prescriptions prior to administration, suggest that certain individuals may have had limited initial urgency to be vaccinated or encountered additional barriers to vaccination, even after receiving a recommendation and prescription from their healthcare provider. Such results highlight an opportunity for pharmacists to reinforce the recommendation for vaccination when receiving a prescription.
High uptake following a documented HCP recommendation via prescription in the present analysis further highlights the importance of the providers’ role in patients receiving recommended vaccines.14–17 A recent poll by the Kaiser Family Foundation indicated that, although US adults’ trust in various health institutions eroded between 2023 and 2025, physicians remain the most trusted source for health information.18 Although HCPs report strong recommendations for patients to receive RZV and other adult vaccines, the strength of such recommendations and the proportion of HCPs recommending these vaccines has decreased since the start of the COVID-19 pandemic, a concerning trend given the influence of HCP recommendations in vaccination decision-making.19 Despite these trends, the current study observed that the rate of RZV administration was significantly higher for prescriptions that occurred during years impacted by the COVID-19 pandemic. This could suggest that those who received prescriptions despite the significant societal disruptions of the pandemic had higher care-seeking behaviors or motivation to be vaccinated with RZV.
In the current study, most RZV prescriptions were written by primary care physicians or internal medicine providers, and during wellness/preventive care visits. Although the likelihood of RZV uptake was higher among those with immunocompromising or autoimmune conditions, very few prescriptions were written by specialty providers. As such, missed opportunities for RZV prescription or administration may remain among those patients receiving care from specialists. Moreover, these findings highlight the opportunity for specialists to embrace increased vaccination responsibilities via strong advocacy for vaccination and/or in-office administration, as specialists are well-positioned to evaluate clinical considerations for vaccination specific to their patients’ underlying conditions and any other ongoing treatments.20 Although a lack of prescription may not be indicative of a lack of recommendation, effective care coordination and information exchange between primary care and specialist providers is essential to ensure all patients receive their recommended vaccines.
Multivariable analyses indicated that nonmedical factors, such as household income, regionality, insurance type, and race and ethnicity, were associated with RZV uptake, underscoring possible SDoH-associated barriers to vaccination among those who are potentially close to the point of vaccination (ie, received a recommendation and prescription from an HCP). Previous research has also shown variations in RZV uptake by SDoH,3,4 and additional barriers to HZ vaccination may include gaps in HCP knowledge of HZ vaccine recommendations, reimbursement problems, health care accessibility, level of knowledge and trust in vaccines, and out-of-pocket costs.20–22 In the present analysis, patients with MAPD plan vs commercial insurance had a significantly higher rate of receiving RZV following a prescription. Notably, being older than 70 years was significantly associated with lower likelihood of vaccine uptake, a concerning finding as the risk and burden of HZ increases with age, mainly attributed to complications of the condition.23–25 Low uptake among older adults may be indicative of obstacles faced by this population, such as difficulty traveling. As provider recommendations are influential in vaccination decision-making, leveraging strong recommendations alongside other strategies (eg, patient education) may encourage greater uptake of HZ vaccines and other recommended adult vaccines.
To our knowledge, no previous studies assessed the uptake of RZV or other adult vaccines specifically among those with a prescription. As such, the estimated uptake with at least 1 dose of RZV (71%) was higher in the current study relative to national estimates in older US adults.3 This finding is expected given that the study population was health care–engaged and had already received a documented HCP recommendation/prescription. Importantly, although vaccine uptake was high among those with an RZV prescription, overall utilization of prescriptions was low, as only 1.8% of patients aged 50 years and older with available records had received a prescription during the study period. Additional analysis comparing receipt of RZV between those who received a recommendation for RZV and a prescription and those who only received a recommendation would be a valuable direction for future research to further clarify the impact of prescriptions on RZV uptake. This comparison was not possible in the current analysis, as provider recommendations for vaccines among those without prescriptions could not be broadly identified in the available structured data.
LIMITATIONS
This study was subject to several limitations. For instance, some prescriptions may not have been captured if the HCP was not covered by the Optum EHR database. The distribution of time from prescription to administration data was also skewed by outliers from patients who received RZV several years after prescription, with the maximum latency value as high as 1,855 days (ie, approximately 5 years). Included patients were enrolled in a commercial or MAPD health plan during the study period; therefore, findings may not be generalizable to uninsured populations or adults insured with Medicare fee-for-service or Medicaid. Certain limitations are associated with data on socioeconomic measures (eg, education level, household income), including inaccuracy in assignment of socioeconomic status, missing data, and predefined categorizations. Other adult vaccines have varying eligibility criteria; thus, the proportions of RZV coadministration and coprescription by vaccine types may not be directly compared. Excluding patients who lack select demographic information (eg, age, sex, geography) may impact the interpretation of results if the vaccine-related behaviors of those unobserved differ from those included in the analysis. However, these counts were a small proportion of the overall population. Coprescription and coadministration for some adult vaccines (eg, COVID-19) were not included in the analysis, likely resulting in an underestimation of the overall rate of coprescription and coadministration of RZV with other vaccines.
Conclusions
HZ vaccination is likely following an HCP recommendation, as shown by the high uptake observed among adults who received RZV prescriptions in this study. Prescriptions for RZV are seldom used in clinical practice but may be considered by providers when seeking to address unmet vaccination needs in older adults. Delayed or missed vaccinations among some adults who have received a prescription highlight opportunities for pharmacists to reinforce vaccine recommendations.
Disclosures
This study was sponsored by GlaxoSmithKline Biologicals SA (Study identifier: VEO-000693). Support for third-party writing assistance for this article, provided by Clare Wiberg, Costello Medical, USA, was funded by GSK in accordance with Good Publication Practice (GPP 2022) guidelines (https://www.ismpp.org/gpp-2022).
Mr. Carrico is an employee of and holds financial equities in GSK. Dr. Zhu is an employee of Optum Life Sciences, a business unit from UnitedHealth Group, which was contracted by GSK to conduct this study, holds financial equities in UnitedHealth Group; Ms. Le is an employee of Optum Life Sciences, a business unit from UnitedHealth Group, which was contracted by GSK to conduct this study, holds financial equities in UnitedHealth Group; Ms. Steffens is an employee of Optum Life Sciences, a business unit from UnitedHealth Group, which was contracted by GSK to conduct this study, holds financial equities in UnitedHealth Group; Ms. Gallagher is an employee of Optum Life Sciences, a business unit from UnitedHealth Group, which was contracted by GSK to conduct this study, holds financial equities in UnitedHealth Group; Mr. Stempniewicz is an employee and holds financial equities in GSK; and Dr. Gatwood is an employee and holds financial equities in GSK, previously received grants or contracts from Merck & Co., AstraZeneca and GSK, consulting fees from Genentech and Janssen, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen and Merck & Co., support for attending meeting and/or travel from Hematology/Oncology Pharmacy Association.
Acknowledgments
The authors acknowledge Seongbin Shin, GSK, USA, for publication management. The authors also thank Costello Medical for editorial assistance and publication coordination, on behalf of GSK, and acknowledge Clare Wiberg, Costello Medical, USA, for medical writing and editorial assistance based on authors’ input and direction. The authors also acknowledge Randall Gerdes and Yiyu Fang, Optum, USA, for statistical programming.
Data Availability
The data contained in our database contains proprietary elements owned by Optum and, therefore, cannot be broadly disclosed or made publicly available at this time. The disclosure of these data to third-party clients assumes certain data security and privacy protocols are in place and that the third-party client has executed our standard license agreement, which includes restrictive covenants governing the use of the data.
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