Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

Abstract

BackgroundAround 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system.MethodsAdministrative healthcare data collected over the period of April 1st 1997 to March 31st 2014 were analyzed to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care, and hospitalizations within each year.ResultsThe incidence of HZ increased by 49.5% from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14.Drug costs rose significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to $127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p <0.0001) from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI; $74.08, $83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95% CI; $284, $511) to $195/episode (95% CI; $129, $260).Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7% lower than the 1997/98 costs of $2,095,633.ConclusionA significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21% increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts.The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3% in the last 4 study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population.

Herpes zoster in kidney transplant recipients: protective effect of anti-cytomegalovirus prophylaxis and natural killer cell count. A single-center cohort study

“…Despite advances in immunosuppression and post‐transplant care, the burden due to post‐transplant HZ has remained largely unchanged over the last decades, as suggested by comparison of our incidence rate between 2008 and 2013 (0.057 episodes per 1000 transplant‐days) to that observed in the US Veterans Administration between 1996 and 2007 (0.068 per 1000 transplant‐days) . Moreover, the rates of PHN found by us and others more than triple that of the overall population .…”

Herpes Zoster in the Older Adult

“…1 This is occurring globally and appears to be independent of demographic shifts seen with a growing elderly population and increased prevalence of immunocompromised individuals. 1–3 …”

“…25 Due to this lack of a consensus definition and the varying age ranges of the populations being studied, the incidence of PHN after HZ ranges from 5–30% and occurs in 50% of HZ affected individuals greater than 85 years. 2, 3, 5, 26–28 It is considered the most debilitating sequelae of HZ since it impairs the affected individual’s quality of life across all 4 health domains: physical, psychological, functional and social. 27 …”

Herpes Zoster in Diverse Situations: A Review

“…The most threatening future of HZ burden is the rising cost, driven primarily by demographic factors of increasing and aging population [91]. Similarly, vaccine uptake is low especially among the blacks where it is available and not freely available for use in many African nations.…”