Incremental 1-Year Medical Resource Utilization and Costs for Patients with Herpes Zoster from a Set of US Health Plans

Abstract

The medical RU and cost data were obtained from the MarketScan Research Database for the years 1998-2003. This database contains inpatient, outpatient and prescription drug data for approximately 14 million individuals of all ages, covered under a variety of fee-for-service and capitated provider reimbursement arrangements, including those with Medicare and private insurance. The work loss estimates were based on the MarketScan Health and Productivity Management Database. Claims for services incurred between 1 January 1998 and 31 December 2003 were screened to identify a cohort of HZ patients based on the presence of at least one International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 053.xx. Each patient was assigned an index date based on the earliest observed occurrence of an HZ diagnosis. A cohort of PHN patients was identified as a subset of the HZ cohort with ICD-9 codes 053.12, 053.13, 053.19 or 729.2x in the period of 90 days to 12 months after the index date. Multivariable regression was used to compare HZ cases with matched controls after adjusting for demographic characteristics, insurance status, co-morbidities and medical expenditure in the 6 months prior to diagnosis for each of the endpoints. Separate regression models were developed, in which age and immune status were stratified. All costs were adjusted to March 2008 values using the medical care component of the Consumer Price Index. The average per patient cost of all HZ cases was $US605 in the first 90 days after diagnosis and $US1052 at 1 year. For the subset with PHN, the average per patient cost of HZ at 1 year was $US3815. For the subset with an immunocompromising condition, the average HZ cost at 1 year was $US1745. The majority of the costs were the result of outpatient visits and prescription drugs. The subset of HZ cases that had both absence hour and short-term disability (STD) records available had 26.5 absence hours and 2.9 STD days. Healthcare utilization, medical care costs and work loss all increased with age for all HZ cases. Based on the results from the present study, the direct medical cost burden of HZ in the US is high, exceeding $US1000 per HZ patient. This direct medical cost may be nearly twice as high in immunocompromised patients and four times as high in the subset of HZ cases with PHN. The direct medical cost burden of HZ may exceed $US1 billion annually in the US. The majority of medical RU and cost burden is incurred by the elderly. Although many people with HZ may no longer be in the workforce, HZ does contribute to lost work time.

Herpes zoster and postherpetic neuralgia in Catalonia (Spain)

“…[8][9][10][11][12] The cost of treatment, especially of PHN is also very significant. 13 For these reasons, HZ and its complications are a serious public health problem, causing a significant health and economic burden, and a significant loss of quality of life due to the pain caused by the disease and its complications. 12,13 There is considerable information in Spain on the incidence of HZ that comes from population-based epidemiologic studies , and angela Domínguez…”

Herpes Zoster-Attributable Resource Utilization and Cost Burden in Patients With Solid Organ Transplant

“…White et al (7) attributed costs to HZ using regression analyses based on all services received by patients, with the incremental cost estimate reflecting the difference between HZ and control patients. Dworkin et al (12) used a similar methodology.…”

“…This period was selected because it provides cost information without introducing ''noise'' related to medical resource utilization for nonYHZ-related care during the longer follow-up period. Previous research has shown that the majority of HZ-related costs are incurred during this earlier time period (7,11). The current study adapted the medication list used in the Insinga et al to include new classes of drugs and new entries within existing drug classes that may be used in the management of HZ (8).…”

“…Gourishankar et al (4) found that approximately 9% of solid organ transplant recipients developed HZ; the majority developed HZ within 1 to 2 years following the procedure. Although research indicates that costs are almost twice as high among patients with both HZ and an immunocompromising condition relative to patients with only HZ infection (7,8), few studies have examined the incremental impact of HZ within an immunocompromised population. Studies that have evaluated costs of HZ in immunocompromised patients have evaluated the population as a whole and have not focused on subpopulations of interest.…”

Infectious Skin Diseases: A Review and Needs Assessment

“…In a 2004 study, the economic burden of cutaneous herpes simplex and herpes zoster infections together was estimated at $1.7 billion annually in the United States. 55 Herpes zoster 91 Herpes genitalis infections account for more than $200 million of this total, 92 so the annual economic burden of other cutaneous herpes infections, including herpes labialis, may be extrapolated to be nearly $500 million annually. These values represent rough estimates based on separate analyses and so must be interpreted carefully.…”