Friesen Kevin J, Chateau Dan, Falk Jamie, Alessi-Severini Silvia, Bugden Shawn
College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Department of Community Health Sciences, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
BMC Infect Dis. 2017 Jan 13;17(1):69. doi: 10.1186/s12879-017-2185-3.
Around 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system.
Administrative healthcare data collected over the period of April 1 1997 to March 31 2014 were analyzed to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care, and hospitalizations within each year.
The incidence of HZ increased by 49.5% from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14. Drug costs rose significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to $127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p <0.0001) from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI; $74.08, $83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95% CI; $284, $511) to $195/episode (95% CI; $129, $260). Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7% lower than the 1997/98 costs of $2,095,633.
A significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21% increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts. The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3% in the last 4 study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population.
约30%的人口会经历带状疱疹（HZ），其中10%会发展为带状疱疹后神经痛（PHN）。这些疾病共同给医疗系统带来了巨大的经济负担。
分析1997年4月1日至2014年3月31日期间收集的行政医疗数据，以使用直接医疗成本确定HZ对医疗系统的负担。使用国际疾病分类（ICD）代码识别HZ发作。通过分段回归分析年龄调整（AA）HZ发病率的趋势。确定每年药物治疗、医疗护理和住院的年度总成本和每次发作成本。
从1997/98年到2013/14年，HZ发病率增加了49.5%。AA发病率的分段回归显示，从1997/98年到2008/09年的一个断点，AA发病率稳定在4.7例/1000人年（PY），之后发病率开始上升，在2013/14年达到5.7例/1000 PY。药物成本从每发作89.77美元（95%CI：82.96美元，96.59美元）显著上升（p<0.03）至每发作127.34美元（95%CI：117.24美元，137.44美元）。医疗成本从每发作57.98美元（95%CI；55.26美元，60.70美元）增加（p<0.0001）至每发作78.84美元（95%CI；74.08美元，83.61美元）。住院率从1997/98年的3.10%下降至2011/12年的1.36%，导致成本从每发作397美元（95%CI；284美元，511美元）降至每发作195美元（95%CI；129美元，260美元）。2011/12年HZ和PHN的年度总成本为1,997,183美元，比1997/98年的2,095,633美元低4.7%。
观察到HZ病例年度数量显著增加，主要由人口因素驱动。AA发病率增加21%表明HZ发病率的变化超出了人口结构变化预期的范围。HZ发病率大幅上升，每次发作的医疗和处方成本增加，但住院率急剧下降抵消了这些影响，其净效应是使总成本相对保持不变。然而，在研究的最后半年，住院率下降速度放缓，在最后4个研究年度稳定在1.3%。HZ负担未来可能会上升，主要由人口增长和老龄化的人口结构变化驱动。
