RTI Health Solutions, Research Triangle Park, NC, United States.
GSK, Philadelphia, PA, United States.
Vaccine. 2019 Feb 21;37(9):1235-1244. doi: 10.1016/j.vaccine.2018.11.079. Epub 2019 Jan 23.
BACKGROUND/OBJECTIVES: Herpes zoster (HZ) incidence increases with age, and the burden of HZ is expected to grow with aging of populations worldwide. We aim to determine the incremental healthcare resource utilization and associated costs of patients with common HZ-related complications other than postherpetic neuralgia (cutaneous, neurologic and ophthalmic) compared to uncomplicated HZ.
We conducted a retrospective cohort study of commercial health insurance claims covering about 40 million immunocompetent individuals aged ≥50 years at study entry from all over the US, from 2008 to 2013, with follow-up for one year after HZ onset. All-cause healthcare resource utilization and direct healthcare costs were recorded and calculated from six months before until 12 months after HZ onset. The mean costs for HZ patients with complications were compared to the mean costs for patients with uncomplicated HZ. Multivariable regression analyses estimated mean incremental costs adjusted for demographics, comorbidities, type of complication and time period.
Over the five-year study period, 22,948 HZ patients (60% women, median age 62 years) who experienced at least one of the selected complications were compared to 213,232 patients (63% women, median age 61 years) with uncomplicated HZ. Overall, the mean annual incremental unadjusted costs for the patients with HZ-related complications were US$4716, ranging from US$2173 for ophthalmic to US$18,323 for neurologic complications. Most of the incremental costs associated with HZ complications were accrued during the first quarter after HZ onset. For each complication type the incremental costs increased with age up to, but not including the oldest group, aged ≥80 years.
Approximately 10% of immunocompetent older patients with HZ develop complications which considerably increase the economic burden of HZ. Vaccination of older adults will offset some of the burden of HZ, including costs associated with HZ-related complications.
背景/目的：带状疱疹（HZ）的发病率随年龄增长而增加，预计随着全球人口老龄化，HZ 的负担将会增加。我们旨在确定除带状疱疹后神经痛（皮肤、神经和眼部）以外的常见 HZ 相关并发症患者与无并发症 HZ 患者相比，其额外的医疗资源利用情况和相关成本。
我们对来自美国各地的约 4000 万免疫功能正常的 50 岁及以上个体的商业健康保险理赔数据进行了回顾性队列研究，这些个体在研究开始时均患有 HZ，随访时间为 HZ 发病后一年。记录并计算了 HZ 发病前六个月至发病后 12 个月期间的所有原因医疗资源利用情况和直接医疗费用。将并发症 HZ 患者的平均费用与无并发症 HZ 患者的平均费用进行比较。多变量回归分析估计了调整人口统计学因素、合并症、并发症类型和时间段后，平均增量成本。
在五年的研究期间，与 213232 名（63%为女性，中位年龄 61 岁）无并发症 HZ 患者相比，22948 名（60%为女性，中位年龄 62 岁）患有至少一种选定并发症的 HZ 患者接受了比较。总体而言，患有 HZ 相关并发症的患者未经调整的年度平均增量费用为 4716 美元，范围从眼部并发症的 2173 美元到神经并发症的 18323 美元。与 HZ 并发症相关的大部分增量成本发生在 HZ 发病后的第一个季度。对于每种并发症类型，增量成本随着年龄的增长而增加，但不包括年龄最大的 80 岁及以上组。
大约 10%的免疫功能正常的老年 HZ 患者会发生并发症，这大大增加了 HZ 的经济负担。为老年人接种疫苗将减轻 HZ 的部分负担，包括与 HZ 相关并发症相关的成本。
