Herpes zoster related healthcare burden and costs in immunocompromised (IC) and IC-free populations in England: an observational retrospective database analysis

Abstract

ObjectiveIndividuals with immunocompromised (IC) conditions are at a higher risk of developing herpes zoster (HZ) than IC-free individuals. This study assessed the healthcare resource utilisation (HCRU) burden and costs, of HZ in IC and IC-free individuals ≥18 years of age (YOA).MethodsWe conducted an observational retrospective study in a cohort of IC (n=621 588) and IC-free (n=621 588) individuals, matched by age, gender and General Practitioner practice region, contributing to the Clinical Practice Research Datalink database from 2000 to 2012 and linked to the Hospital Episode Statistics inpatient data. HCRU (ie, primary and secondary care consultations, hospital inpatient stays and treatment prescriptions) was analysed from 7 days before to: (1) 30, (2) 365 days after the HZ diagnosis date for individuals with (1) HZ only (no postherpetic neuralgia (PHN)) and (2) individuals with HZ and PHN only. Healthcare costs were computed by multiplying the number of units of resources used by the unit costs, summed across all HCRU categories to obtain a total cost per subject. Values were expressed in 2014 UK pound sterling (£) and presented for HZ cases overall, stratified by age (ie, 18–49, 50–59, 60–69, 70–79 and ≥80 YOA) and IC status.ResultsThe percentage of HZ cases requiring hospitalisation was higher in IC individuals (2.7% vs 0.4% in IC and IC-free individuals aged 18–49 YOA, respectively and 9.5% vs 7.5% in IC and IC-free individuals aged ≥80 YOA, respectively). Similarly, HZ-related mean treatment costs per subject were higher in IC individuals (£189 vs £104 in IC and IC-free individuals aged 18–49 YOA, respectively and £557 vs £401 in IC and IC-free individuals aged ≥80 YOA, respectively). Costs varied considerably by IC condition.ConclusionsIndividuals with IC conditions, have a high burden of HZ, associated with an increased risk of HZ and high HZ-related healthcare costs.

Risk of herpes zoster (shingles) in patients with rheumatoid arthritis under biologic, targeted synthetic and conventional synthetic DMARD treatment: data from the German RABBIT register

“… 23 Healthcare utilisation and costs are about doubled in patients with RA and HZ compared with persons with HZ without immunosuppression. 24 …”

“…23 Healthcare utilisation and costs are about doubled in patients with RA and HZ compared with persons with HZ without immunosuppression. 24 In terms of a risk assessment with regard to vaccination, this suggests that especially elderly patients with higher glucocorticoid doses and patients for whom tsDMARD therapy is planned should be considered for vaccination. Preliminary data from tofacitinib-treated patients with RA indicate the possibility of reducing the risk of HZ by vaccination.…”

Reply to: “Herpes zoster seven days after SARS-CoV-2 vaccination in a patient with ankylosing spondylitis under adalimumab” by Josef Finsterer

“…Only in 2021, the Food and Drug Administration (FDA) expanded the indication for recombinant zoster vaccine to include adults aged ≥18 years who are or will be at increased risk for HZ because of immunodeficiency or immunosuppression caused by diseases or therapies (13,14). Therefore, recent debate and attention inevitably focused on VZV reactivation, questioning on the available vaccines in preventing HZ complications, which lead to healthcare resource utilization and healthcare associated costs (15)(16)(17)(18). In conclusion, considering all these efforts and the current pandemic challenge, we believe that now more than ever we are asked to quickly detect potential adverse events, even extremely rare and mild ones, and to face them, in order to support the robust pharmacovigilance campaign for SARS-CoV2 vaccination (19,20).…”

Shingles, Zostavax vaccination and risk of developing dementia: a nested case–control study—results from the UK Biobank cohort

“…12 In the UK, the incidence of HZ increases from 7.1 per 1000 person-years among those aged 60-64 years old to 12.2 per 1000 among individuals aged ≥85 years. 13 The lifetime risk of HZ is around 10%-30%. 14 People with a weakened immune system are at higher risk of shingles.…”