Carapetis Jonathan R, Russell Diana M F, Curtis Nigel
Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.
Vaccine. 2004 Dec 21;23(6):755-61. doi: 10.1016/j.vaccine.2004.07.025.
Economic analyses of varicella-zoster virus (VZV) immunisation are sensitive to the costs of hospitalised cases, so there is a need to validate VZV hospitalisation data.
To assess the accuracy of hospital VZV coding data and to apply these parameters to a population-based sample to estimate incidence and costs.
A 3-year retrospective chart review from one hospital to document clinical features and validate coding data. A separate 9-year analysis of discharge data from two hospitals draining a defined region of suburban Melbourne, with adjustment for miscoding and estimates of direct hospital costs.
After correction for miscoding, 224 patients were admitted to one hospital over 3 years, 79% with varicella and 21% with zoster. Miscoding resulted in a 15% underestimate of zoster cases and a 4% overestimate of varicella cases. Thirty-six percent of varicella admissions compared to 80% of zoster admissions were immunocompromised and/or had chronic disease. Compared to otherwise-healthy patients, immunocompromised patients were admitted earlier in their illness and had lower complication rates. Forty-two percent of immunocompromised/chronic disease patients with varicella had a known exposure, usually from a family member. The incidence of hospitalised varicella and zoster in under 15-year olds was 15.7 and 1.8 per 100,000 per year, respectively. This suggests that there are 615 varicella hospitalisations and 72 zoster hospitalisations in this age group each year in Australia, at a total direct cost of over 2.2 million AU dollars.
These results highlight the considerable burden of hospitalised zoster and the importance of immunising non-immune contacts of immunocompromised individuals. They also support previous estimates of the incidence of hospitalised varicella in Australian children and adolescents, although direct medical costs may be higher than those previously estimated.
水痘带状疱疹病毒（VZV）免疫接种的经济分析对住院病例的成本很敏感，因此有必要验证VZV住院数据。
评估医院VZV编码数据的准确性，并将这些参数应用于基于人群的样本，以估计发病率和成本。
对一家医院进行为期3年的回顾性病历审查，记录临床特征并验证编码数据。对墨尔本郊区一个特定区域的两家医院的出院数据进行单独的9年分析，对错误编码进行调整并估计直接医院成本。
校正错误编码后，3年内有224名患者入住一家医院，79%为水痘患者，21%为带状疱疹患者。错误编码导致带状疱疹病例低估15%，水痘病例高估4%。水痘入院患者中有36%，而带状疱疹入院患者中有80%存在免疫功能低下和/或患有慢性病。与健康患者相比，免疫功能低下的患者在疾病早期入院，并发症发生率较低。42%的免疫功能低下/患有慢性病的水痘患者有已知的接触史，通常来自家庭成员。15岁以下儿童住院水痘和带状疱疹的发病率分别为每年每10万人15.7例和1.8例。这表明在澳大利亚，该年龄组每年有615例水痘住院病例和72例带状疱疹住院病例，直接总成本超过220万澳元。
这些结果突出了住院带状疱疹的巨大负担以及对免疫功能低下个体的非免疫接触者进行免疫接种的重要性。它们还支持了先前对澳大利亚儿童和青少年住院水痘发病率的估计，尽管直接医疗成本可能高于先前估计。
