1. Knowledge, Attitudes and Beliefs of Older Canadians and Their Healthcare Providers Regarding Shingles Vaccine D Shaw, D Cravit & S McNeil June 2, 2008

2. Background Shingles (herpes zoster) carries a significant burden of disease – particularly in those over 60y 130,000 cases of shingles 360,000 health care visits 17,000 cases of post-herpetic neuralgia (PHN) 2,000 hospitalizations Contributes to 20 deaths Annual healthcare cost est $69 million Brisson M. J Infect. 2002

3. Shingles Vaccine New live-attenuated vaccine against shingles (Zostavax , Merck) to be approved in Canada in near future 0255075100 Vaccine Efficacy (%) BOI PHN Zoster 95% CI

4. Objectives 1. What is the perceived burden of illness of shingles among Canadians over 60y? 2. Are older Canadians willing to receive the shingles vaccine? 3. Are healthcare providers for older Canadians (family, internal, geriatrics, infectious diseases, dermatology) willing to recommend the shingles vaccine? 4. Who do these groups think should pay for the shingles vaccine?

5. Methods Surveys designed, tested for content validity and test-retest reliability and piloted Web-based survey emailed to members of the Canadian Association of Retired Persons aged  60y Web-based and paper-based survey distributed to NS physicians- Family Medicine, Internal Medicine, Geriatrics, Dermatology, Infectious Diseases

6. Results 603 older Canadian responses; all Provinces and Territories represented 161 NS physician responses (25% response rate) No differences in main outcomes by age, gender, province/territory of residence (older), education (older), income (older), specialty of medicine (physician), years spent in practice (physician)

7. Results – Burden of Shingles 48% of older Canadians reported at least one episode of shingles 40% experienced PHN 82% older Canadians had friend/family member with shingles

8. Results- Vaccine Acceptability 87% of older Canadians willing to receive the vaccine if safe and recommended by physician 87% think vaccine should be publicly funded for those over 60y 67% willing to pay out-of-pocket 93% of NS physicians indicated willing to recommend vaccine if it prevents shingles 94% of NS physicians think vaccine should be publicly funded for those over 60y

9. Results- Factors associated with older Canadian willingness to receive shingles vaccine (regression)

10. Results: Variables associated with Physician willingness to recommend shingles vaccine

11. Summary Shingles associated with significant burden of illness Majority of older adults would accept vaccine if recommended by their physician (87%) 93% of NS physicians responsible for healthcare of elderly intend to recommend shingles vaccine Majority of older adults (87%) and physicians (94%) believe that shingles vaccine should be publicly funded for older Canadians; smaller majority of older Canadians willing to pay for shingles vaccine out-of- pocket

12. Conclusion Demand for the shingles vaccine is likely to be high among older Canadians and their healthcare providers Careful consideration of program feasibility and cost effectiveness of publicly-funded shingles vaccine is warranted

13. Acknowledgements Dalhousie Music-in-Medicine Program Capital Health Research Fund Brian Hoyt Petra Rykers Kimberly Brooks

14. Questions