Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population

Abstract

OBJECTIVE:To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. PATIENTS AND METHODS:Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. RESULTS:The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. CONCLUSION:The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older. © 2009 Mayo Foundation for Medical Education and ResearchN early 1 million new cases of herpes zoster (HZ) occur annually in the United States. 1,2 Herpes zoster results from reactivation of the varicella-zoster virus, which remains dormant after infection with chickenpox. Declining cellular immunity associated with aging and immunocompromising conditions increase the risk of HZ and HZ complications. [3][4][5] However, most HZ cases (>90%) occur in immunocompetent people. 1,2 Herpes zoster can adversely affect a person's health-related quality of life 6-8 because of complications such as eye and other nonpain complications 2 as well as acute and chronic pain (postherpetic neuralgia [PHN]) that can result in severe activity limitations and sleep disturbances. 2,6,9 Claims data have been used to estimate the health care utilization (HCU) and cost of HZ in the United States. 10,11 However, such data have potential limitations. Claims data may not capture all the HCU and costs attributable to the complications of HZ, including PHN and nonpain complications. In the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), 12 few HZ complication-specific diagnostic codes are available, and they may not be used reliably. Although there is an ICD-9-CM diagnostic code for PHN, there is no standard definition for PHN that is used by all physicians. In addition, not all HZ-related visits are coded with a zosterspecific diagnostic code, especially visits that occur before definitive diagnosis. Medications, laboratory tests, and procedures are not directly linke...

Herpes zoster and postherpetic neuralgia in Catalonia (Spain)

“…The study by Yawn et al, 7 one of the most comprehensive epidemiological studies of HZ, found similar incidence rates to those observed in Spain, as did other studies performed in Europe, [25][26][27][28][29] Israel, 30 and the United States. 31 The present study is the first in Spain to estimate the incidence of PHN by direct analysis of data from the medical records of patients and not through secondary sources (primary healthcare or hospital registers).…”

Risk of herpes zoster in children with asthma

“…Details of study subjects were previously described. 8,27,28 Briefly, HZ cases were initially identified by the International Classification of Diseases, 9th Revision (ICD-9) codes (053.xx), and medical records for each potential subject were reviewed to verify that the subject was indeed a new case of HZ, based on predetermined criteria for HZ. Confirmation required a characteristic rash (i.e., vesicular rash on a dermatome) and signs or symptoms of pain or itching at the rash site, in addition to a physician's diagnosis of HZ.…”

Herpes zoster vaccine effectiveness and manifestations of herpes zoster and associated pain by vaccination status

“…1 HZ significantly impacts on health, quality of life and medical costs; 1-3 the impacts increase with age. 2,[4][5][6] The primary burden of HZ is pain. 7,8 HZ pain typically occurs acutely but can persist after the rash resolves (postherpertic neuralgia [PHN]); 8% to 27% of HZ patients report pain lasting at least 3 months following rash onset.…”