Elsevier

Mayo Clinic Proceedings

Volume 84, Issue 9, September 2009, Pages 787-794
Mayo Clinic Proceedings

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

https://doi.org/10.4065/84.9.787Get rights and content

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.

Section snippets

Source of Data

Olmsted County provides a unique setting for population-based studies by allowing all county residents' medical care to be followed up across all health care systems within the county. All patients have visit-specific records kept within their care facility, and visit-specific diagnostic and procedure codes are warehoused within the Rochester Epidemiology Project (REP) database.14, 15, 16 We searched the REP database for all patients who were residents of Olmsted County and who had a diagnostic

Summary of Study Population

Of the 2131 potential HZ cases among patients 22 years or older identified in the Olmsted County REP database, 462 were excluded from the study, 172 for administrative reasons and 290 for clinical reasons. Administrative reasons were as follows: patients were not residents of Olmsted County at the time of diagnosis (n=137), HZ diagnosis occurred beyond the study window (n=7), condition diagnosed outside Olmsted County with no specifics (n=12), and research refusal (n=16). The reasons for

DISCUSSION

The results of the current study suggest that reliance on claims data may not capture all the HCU and costs associated with PHN and nonpain complications related to HZ. Both Yawn et al2 and Insinga et al10 estimated that 1 million new episodes of HZ occur each year in the United States. However, the mean HZ-related health care cost per case beginning 3 weeks before diagnosis through 90 days after diagnosis was $1112 using medical record data compared with the estimate of $431 reported by

CONCLUSION

Herpes zoster is a common condition, and nearly 20% to 25% of HZ patients experience 1 or more complications, including PHN or other nonpain complications. Any type of complication more than triples the cost of HZ-related care. The medical care cost of treating incident HZ cases in the United States, extrapolated from the results of the current study, is estimated at $1.1 billion annually. Although people with immunocompromising conditions are more likely to have PHN or other nonpain

Acknowledgments

We appreciate the help of Dawn Littlefield, BS, in preparation of the submitted manuscript and Melissa Whipple-Neibauer, MS, for her technical and scientific support.

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This work was funded by grants from Merck Research Laboratories, North Wales, PA, and the National Institutes of Health (AR30582).

Drs Itzler, Pellissier, and Saddier are employees of Merck & Co, which has a zoster vaccine that was recently approved by the Food and Drug Administration. Ms Sy was an employee of Merck Research Laboratories at the time this work was completed.

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