Bongers Leonard D, Navarini Alexander, Berger Christoph T, Mueller Simon M
Department of Dermatology, University Hospital Basel, Switzerland.
Vaccination Clinic, Department of Medicine, University Hospital Basel, Switzerland.
Swiss Med Wkly. 2021 Dec 28;151:w30081. doi: 10.4414/smw.2021.w30081. eCollection 2021 Dec 20.
Herpes zoster is the common reactivation of latent varicella zoster virus infection and is associated with substantial morbidity and costs. Age, immunosuppression, diabetes and active cancer are important risk factors for developing herpes zoster. The recombinant herpes zoster vaccine is highly effective in preventing this infection. To inform cost-effectiveness analyses of vaccination in risk groups, it is important to define the rates of complications, mortality, and hospitalisation and its costs.
In this single-centre, investigator-initiated, retrospective study we analysed herpes zoster patients treated in our tertiary dermatology referral centre between 2005 and 2019. Case costs were calculated using health insurance invoices and by estimating the drug-related costs. The associations between patients' characteristics and complications were assessed using logistic regression models.
A total of 355 herpes zoster patients were analysed (mean age 61.5 ± 18.8 years; 56.6% women). The complication rate was 30.1% (n = 107) with post-herpetic neuralgia being the most frequent (37/355, 10.4%). The herpes zoster-related hospitalisation rate was 19.2% (n = 68), the herpes zoster-related mortality rate 0.85% (n = 3). Of all patients, 22.8% (n = 81) had herpes zoster risk factors. The odds ratio for complications (multivariate analysis) was 2.5 (95% confidence interval [CI] 1.12-5.72) in cancer patients and 1.04 (1.02-1.05) for each additional year of age (1.41 for 10 years). The cost ratio (median) of in- vs outpatient treatment was 26.9 (CHF/case 9029 vs 335), of all complicated vs non-complicated herpes zoster patients 6.6 (CHF/case 2203 vs 332) and of complicated vs non-complicated herpes zoster outpatients 4.3 (CHF/case 1331 vs 306).
In this herpes zoster population at a university hospital, one in three patients was affected by herpes zoster-related complications. Age and cancer were independently associated with a high complication rate, suggesting a need to vaccinate cancer patients. Herpes zoster-related complications and the need for inpatient treatment escalated the costs per case.
带状疱疹是潜伏的水痘-带状疱疹病毒感染常见的再激活形式，与较高的发病率和成本相关。年龄、免疫抑制、糖尿病和活动性癌症是发生带状疱疹的重要危险因素。重组带状疱疹疫苗在预防这种感染方面非常有效。为了为风险人群接种疫苗的成本效益分析提供信息，确定并发症、死亡率、住院率及其成本的发生率很重要。
在这项由研究者发起的单中心回顾性研究中，我们分析了2005年至2019年期间在我们的三级皮肤科转诊中心接受治疗的带状疱疹患者。病例成本使用医疗保险发票并通过估算药物相关成本来计算。使用逻辑回归模型评估患者特征与并发症之间的关联。
共分析了355例带状疱疹患者（平均年龄61.5±18.8岁；56.6%为女性）。并发症发生率为30.1%（n = 107），其中带状疱疹后神经痛最为常见（37/355，10.4%）。带状疱疹相关住院率为19.2%（n = 68），带状疱疹相关死亡率为0.85%（n = 3）。所有患者中，22.8%（n = 81）有带状疱疹危险因素。癌症患者并发症的比值比（多变量分析）为2.5（95%置信区间[CI]1.12 - 5.72），年龄每增加一岁为1.04（1.02 - 1.05）（10年为1.41）。住院与门诊治疗的成本比（中位数）为26.9（每例瑞士法郎9029对335），所有复杂与非复杂带状疱疹患者为6.6（每例瑞士法郎2203对332），复杂与非复杂带状疱疹门诊患者为4.3（每例瑞士法郎1331对306）。
在这家大学医院的带状疱疹患者群体中，三分之一的患者受到带状疱疹相关并发症的影响。年龄和癌症与高并发症发生率独立相关，提示有必要为癌症患者接种疫苗。带状疱疹相关并发症和住院治疗需求增加了每例的成本。
