Mao Jianbin, McPheeters Jeffrey T, Finelli Lyn
Optum, Eden Prairie, MN Merck & Co., Inc., Kenilworth, NJ.
Medicine (Baltimore). 2017 Dec;96(48):e8746. doi: 10.1097/MD.0000000000008746.
Immunosuppressed patients with solid tumor malignancies (STMs) are particularly vulnerable to herpes zoster (HZ). This study estimated the incidence of HZ and evaluated healthcare resource utilization and costs for persons with STM receiving chemotherapy with and without incident HZ.We conducted a retrospective claims study of adults with STM receiving chemotherapy between January 1, 2010 and June 30, 2014. Patients were followed from their first chemotherapy date through development of HZ, health plan disenrollment, the study end date, or 24 months. HZ incidence was calculated and stratified by patient characteristics. Adjusted HZ incidence was estimated using Poisson regression. Healthcare resource utilization and costs were compared between patients with HZ (cases) and propensity score-matched controls without HZ during a variable follow-up period. Adjusted healthcare costs were estimated using Lin regression to control for informative censoring.Of 155,480 patients with STM receiving chemotherapy, 3100 (2.0%) developed HZ, yielding an adjusted HZ incidence rate of 13.8/1000 person-years (PY). HZ cases (n = 3004) had significantly higher healthcare resource utilization than matched controls (n = 15,020). Adjusted annual costs were $48,077 for cases vs $41,645 for matched controls, corresponding to a differential cost of $6432 annually.After adjustment for potential confounders, patients with STM receiving chemotherapy had an HZ incidence of 13.8/1000 PY; those who developed HZ used more healthcare resources and incurred higher costs than those who did not. These findings suggest that HZ prevention by vaccination could improve outcomes and reduce costs in this population.
实体瘤恶性肿瘤（STM）的免疫抑制患者特别容易患带状疱疹（HZ）。本研究估计了HZ的发病率，并评估了接受化疗且发生或未发生HZ的STM患者的医疗资源利用情况和成本。我们对2010年1月1日至2014年6月30日期间接受化疗的成年STM患者进行了一项回顾性索赔研究。从患者首次化疗日期开始随访，直至发生HZ、退出健康计划、研究结束日期或24个月。计算HZ发病率，并按患者特征进行分层。使用泊松回归估计调整后的HZ发病率。在可变随访期内，比较HZ患者（病例）和倾向评分匹配的无HZ对照患者的医疗资源利用情况和成本。使用线性回归估计调整后的医疗成本，以控制信息删失。在155480例接受化疗的STM患者中，3100例（2.0%）发生了HZ，调整后的HZ发病率为13.8/1000人年（PY）。HZ病例（n = 3004）的医疗资源利用显著高于匹配对照（n = 15020）。病例的调整后年度成本为48077美元，而匹配对照为41645美元，每年的成本差异为6432美元。在对潜在混杂因素进行调整后，接受化疗的STM患者的HZ发病率为13.8/1000 PY；发生HZ的患者比未发生HZ的患者使用更多的医疗资源，费用更高。这些发现表明，通过接种疫苗预防HZ可以改善该人群的结局并降低成本。
