The burden of hospitalisation for varicella and herpes zoster in England from 2004 to 2013

Hobbelen, P.H.F.; Stowe, Julia; Amirthalingam, Gayatri; Miller, Liz; Hoek, Albert-Jan van

doi:10.1016/j.jinf.2016.05.008

Cited by 45 publications

(44 citation statements)

References 33 publications

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“…The mean total direct medical cost per hospitalized case of our entire cohort was USD 4,883, and was similar to the cost per admission for HZ in England (approximately USD 4,946 when adjusted by 5% annual inflation rate to year 2018) reported by a population-based analysis of disease burden. The cost per case in our immunocompetent group (USD 4,049) was also consistent with the cost per admission in the immunocompetent population in England (approximately USD 4,819 when adjusted to year 2018 with 5% annual inflation rate) (10).…”

Section: Discussionsupporting

confidence: 83%

Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong

Ming¹,

Yu²,

Tsang³

et al. 2019

Acta Derm Venerol

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This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Acta Derm Venereol 2019; 99: 616-617 616 Both old age and female sex are well-recognized risk factors in herpes zoster (HZ), and the rate of HZ-related hospitalization is also associated with age (1, 2). Hospitalization costs in Taiwan in 2006 were estimated as USD 1,427 per case of HZ (3). More than 50% of the Hong Kong population are female and 40% are 50 years or older (4). With an ageing population, the disease burden of HZ in Hong Kong is expected to increase.Zoster vaccine is reported to be effective and safe in preventing HZ in adults aged 50 years and above (5, 6), yet it is not included in the current public vaccination programme in Hong Kong. The direct medical cost of treatment of patients hospitalized with HZ is a crucial factor in examining the potential health economic benefits of zoster vaccine against HZ incidence and HZ-related hospitalization. The present study therefore analysed the direct medical costs of HZ in older adult patients in the hospital setting. METHODSA retrospective observational study was conducted in 2 tertiary hospitals of Hong Kong. Patients aged 50 years or older with discharge diagnosis of HZ during the period between 1 January 2011 and 31 December 2013 were included. Patient demogra phics and utilization of healthcare resources for HZ were retrieved from medical records. The resource items were hospital length of stay (LOS), diagnostic tests, drug treatment for HZ and HZ-related complications. The study protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee and the Kowloon West Cluster Clinical Research Ethics Committee.The cost analysis was conducted with 2018 costs from the perspective of the public healthcare provider in Hong Kong. The Hospital Authority is non-profit making and subsidized by the government, and the hospitalization charge billed to non-Hong Kong residents was therefore assumed to represent the cost of healthcare services. The daily charges to non-Hong Kong residents for the general medical ward (USD 654 per day) and intensive care unit (USD 3,128 per day) were found in the Fees and Charges list (7), and the unit cost of medication and laboratory tests were obtained from the study hospitals.Data analysis was conducted with Microsoft Excel 2017 (Microsoft Corporation, Redmond, USA) and SPSS 16.0 (SPSS Inc., Chicago, USA) for Windows. Continuous variables were compared by analysis of variance (ANOVA), and Pearson's χ 2 test was used for comparison of binary variables. To determine predictors of high treatment cost (defined as ≥ 75 th percentile of total direct medical cost), univariate analysis was performed on demographic and clinical factors (with frequency ≥ 5%). The factors with potential association (p ≤ 0.1) were further investigated using backward stepwise logistic models. The odds ratios with 95% confident interval (OR 95% CI) of significant predictors on high cost were reported. A p-value...

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Section: Discussionsupporting

confidence: 83%

Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong

Ming¹,

Yu²,

Tsang³

et al. 2019

Acta Derm Venerol

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“…Varicella is usually more severe in adults, with those aged ≥45 years having 4–50 times greater risk of hospitalization and 174-fold higher risk of dying than individuals aged 5–14 years [8]. Nevertheless, it should be noted that the burden of hospitalization is highest in immunocompetent or previously healthy individuals [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Varicella vaccination - the global experience

Wutzler

Bonanni

Burgess

et al. 2017

Expert Review of Vaccines

143

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Introduction Varicella, although a frequently benign childhood disease, nevertheless represents a considerable health burden. WHO recommends including varicella vaccines in universal routine vaccination programs, and maintaining coverage >80%. Many countries have successfully introduced varicella vaccination and have benefited from lower disease burden, but many others have not adopted the vaccine. Reasons include cost commitment for a ‘mild childhood disease’ or concerns that vaccination will shift varicella to older age groups or increase herpes zoster incidence. Areas covered This literature review summarizes the effectiveness and epidemiological impact of varicella immunization programs. Expert commentary Varicella vaccines are immunogenic with acceptable safety profiles. One and two dose schedules are highly effective against varicella and large reductions in disease incidence, particularly moderate-severe disease, have been widely reported. There is currently no evidence to suggest that the introduction of varicella vaccination results in a shift of varicella disease burden to older age groups. Although epidemiological studies have shown an increased incidence of herpes zoster since the vaccines were launched, there are many other contributing factors, and indeed, this secular trend was evident before their introduction. In conclusion, varicella vaccination easily fits into existing immunization programs and significantly reduces the often underestimated burden of varicella.

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“…PHN is the most common debilitating complication, a neuropathic pain syndrome that persists or develops after the dermatomal lesions have cured 6. PHN may impair the elderly patient's functional status by interfering with basic activities of daily life, resulting in an increased annual medical care cost 7. In addition, ocular nerve and other organ involvement with HZ may occur, often with severe sequelae 6…”

Section: Introductionmentioning

confidence: 99%

Risk and severity of herpes zoster in patients with rheumatoid arthritis receiving different immunosuppressive medications: a case–control study in Asia

et al. 2017

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ObjectiveIncreasing evidence indicates that the risk of herpes zoster (HZ) is elevated in rheumatoid arthritis (RA). Little is known about the epidemiology of HZ in patients with RA in Asia. The aim of this study was to determine the risk factors and outcomes of HZ among patients with RA.DesignA case–control study.SettingA medical centre in Asia.ParticipantsA total of 9025 newly diagnosed and eligible patients with RA (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 714.0) during the period 2001–2014. Among them, 275 (3.05%) were newly diagnosed with HZ (ICD-9-CM code 053.0) after the RA identification. As the control group, patients with RA without HZ were matched for age, gender and RA disease duration at the time of HZ infection with the RA-HZ case group at a ratio of 4:1, and a total of 1100 control subjects were selected.Outcome measuresWe estimated ORs using conditional logistic regression to investigate the risk and severity of HZ among patients with RA receiving different immunosuppressive medications.ResultsExposure to corticosteroids (≥10 mg/day adjusted OR (aOR)=2.30, 95% CI 1.25 to 4.22, p=0.01), anti-tumour necrosis factor biologicals (aOR=2.07, 95% CI 1.34 to 3.19, p=0.001) and conventional synthetic disease-modifying anti-rheumatic drugs (methotrexate (aOR=1.98, 95% CI 1.43 to 2.76, p<0.001) and hydroxychloroquine (aOR=1.95, 95% CI 1.39 to 2.73, p<0.001)) was associated with an increased HZ risk in patients with RA. The association between the use of corticosteroids and HZ risk was dose-dependent (ptrend<0.001). Time-to-HZ diagnosis among patients with RA receiving biological medications was significantly shorter than that in patients not receiving biological medications. A higher proportion of severe HZ and ophthalmic involvement was found in patients with RA receiving biologicals.ConclusionsThere was an increased risk of HZ in patients with RA taking specific immunosuppressive medication. Biologicals used were associated with severe HZ occurrence. Therefore, it is important to closely monitor and prevent severe HZ complications during specific immunosuppressive therapy.

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The burden of hospitalisation for varicella and herpes zoster in England from 2004 to 2013

Abstract: Most of the hospital burden due to VZV-virus in England occurs in the immunocompetent population and is potentially vaccine-preventable.

Cited by 45 publications

References 33 publications

Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong

Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong

Varicella vaccination - the global experience

Risk and severity of herpes zoster in patients with rheumatoid arthritis receiving different immunosuppressive medications: a case–control study in Asia

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