Movahedi Mohammad, Cesta Angela, Li Xiuying, Tatangelo Mark, Pope Janet E, Bombardier Claire
M. Movahedi, MD, PhD, University Health Network, Toronto General Hospital Research Institute, and Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto;
A. Cesta, MSc, X. Li, MSc, M. Tatangelo, PhD, University Health Network, Toronto General Hospital Research Institute, Toronto.
J Rheumatol. 2025 Jun 1;52(6):543-552. doi: 10.3899/jrheum.2024-0911.
Patients with rheumatoid arthritis (RA) have an increased risk of developing herpes zoster (HZ) compared to the general population. We aimed to measure healthcare utilization (HCU) and related costs of HZ among patients with RA, from the public payer's perspective.
Adult patients with RA diagnosed with HZ between 2008 and 2020 were matched by sex, age, and date of HZ infection to (1) patients with RA without HZ, (2) the non-RA population with HZ, and (3) the non-RA population without HZ. Unadjusted gamma distribution models and generalized estimating equations were used to compare HCU costs and the number of clinical events (CEs), including hospital admissions and emergency department and physician visits, in patients with RA with HZ to each matched cohort.
We identified 15,573 patients with RA diagnosed with HZ and a similar number for each of the 3 matched cohorts. From year 1 to year 10, mean total cost ranged from CAD $13,507 to CAD $17,120 for the RA with HZ cohort compared to CAD $12,651 to CAD $14,534 in the RA without HZ cohort. Physician billing and inpatient hospital costs were the largest drivers of increased costs for all cohorts. Compared to patients with RA with HZ, each matched cohort experienced a significantly lower mean number of total CEs, with the highest difference in total CEs 1 year following an HZ infection.
HCU and related costs were higher in patients with RA with HZ compared to patients with RA without HZ and non-RA populations with and without HZ. Treatment strategies that minimize the risk of HZ and encourage patients to keep up to date with vaccinations should be considered.
与普通人群相比，类风湿性关节炎（RA）患者发生带状疱疹（HZ）的风险更高。我们旨在从公共支付方的角度衡量RA患者中HZ的医疗保健利用率（HCU）及相关成本。
将2008年至2020年间诊断为HZ的成年RA患者按性别、年龄和HZ感染日期与以下人群进行匹配：（1）未患HZ的RA患者；（2）患HZ的非RA人群；（3）未患HZ的非RA人群。使用未调整的伽马分布模型和广义估计方程，比较患HZ的RA患者与每个匹配队列的HCU成本及临床事件（CE）数量，包括住院、急诊科就诊和门诊就诊次数。
我们确定了15573例诊断为HZ的RA患者，以及3个匹配队列中数量相近的患者。从第1年到第10年，患HZ的RA队列的平均总成本在13507加元至17120加元之间，而未患HZ的RA队列的平均总成本在12651加元至14534加元之间。医生计费和住院医院成本是所有队列成本增加的最大驱动因素。与患HZ的RA患者相比，每个匹配队列的总CE平均数量显著更低，在HZ感染后1年总CE的差异最大。
与未患HZ的RA患者以及患HZ和未患HZ的非RA人群相比，患HZ的RA患者的HCU及相关成本更高。应考虑采取将HZ风险降至最低并鼓励患者及时接种疫苗的治疗策略。
