Disease, health-care cost reductions among opportunities for plan sponsors around vaccines

Well beyond childhood vaccines and the annual flu shot, the role of vaccines is evolving, from saving lives to improving life-long health and well-being. There is a shift underway with the development of vaccines to prevent or treat chronic conditions in addition to preventing infectious diseases.

“Vaccines offer an opportunity to reduce disease as well as health-care costs,” said Robyn Widenmaier, scientific advisor for vaccines at GlaxoSmithKline, during a presentation at the 2018 Calgary Drug Trends Summit on Oct. 25.

“There is opportunity within the private market, as well as opportunity created by the types of vaccines being developed, and how access to those vaccines will be managed in the future. With many vaccines being developed and constrained public health budgets, we can’t necessarily rely on public health agencies to be the sole funding source for all vaccines for all Canadians, especially due to the shift in the types of vaccines being developed.”

Read: Which health benefits do employees really want?

Many different vaccines are currently in development, including for non-communicable chronic disease in adults. This creates opportunities for how vaccines might be funded in the future, and potentially for how they’re assessed for funding, according to Widenmaier.

Why would a plan sponsor want to cover vaccines in a benefits plan? “It can be a cost-effective approach to protect the health of the population,” she said, noting it’s always better to prevent disease than to try to care for sick patients later.

The shingles vaccine is one example of the preventive role that vaccines can play throughout life, said Widenmaier. It’s estimated that more than 90 per cent of Canadian adults harbour the varicella zoster virus, which causes chickenpox, and that one in three may develop shingles in their lifetime if the dormant virus reactivates later in life. Postherpetic neuralgia, the most common complication of shingles, is very difficult to treat, with persistent pain that can last for months or even years after the initial acute pain and rash has resolved.

“That’s why prevention is so important,” said Widenmaier. The economic burden of this disease can also be significant, she noted, due to the direct medical costs of pharmacological management of chronic neuropathic pain and the use of polypharmacy, as well as indirect costs due to decreased work productivity and absenteeism.

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Even when the public health system funds certain adult vaccines, it’s unlikely that the entire at-risk population will be covered. When vaccines are funded, uptake tends to be much higher, noted Widenmaier. She said vaccine coverage opportunities exist in the private market, where coverage can be expanded, offering potential direct and indirect benefits to employers and insurance companies.

Only a portion of private drug plan members will have access to vaccines through their health benefits plan, said Widenmaier, so adding vaccines into a drug plan represents an opportunity. It makes more sense compared to paying the cost of treating the disease later, she added.

Read more coverage of the 2018 Calgary Drug Trends Summit.