Incremental 1-year medical resource utilization and costs for patients with herpes zoster from a set of US health plans.

BACKGROUND: Nearly 1 million new episodes of herpes zoster (HZ) occur annually in the US, yet little is known about the medical resource utilization (RU) and costs associated with HZ and its complications. OBJECTIVES: To describe the medical RU and cost burden of HZ in the first 90 days and the first year after diagnosis from the health insurer perspective and to stratify this burden for patients diagnosed with post-herpetic neuralgia (PHN) and those who are immunocompromised. In addition, this study explores costs from the societal perspective as a result of work loss in the first year after diagnosis. METHODS: The medical RU and cost data were obtained from the MarketScan Research Database for the years 1998-2003. This database contains inpatient, outpatient and prescription drug data for approximately 14 million individuals of all ages, covered under a variety of fee-for-service and capitated provider reimbursement arrangements, including those with Medicare and private insurance. The work loss estimates were based on the MarketScan Health and Productivity Management Database. Claims for services incurred between 1 January 1998 and 31 December 2003 were screened to identify a cohort of HZ patients based on the presence of at least one International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 053.xx. Each patient was assigned an index date based on the earliest observed occurrence of an HZ diagnosis. A cohort of PHN patients was identified as a subset of the HZ cohort with ICD-9 codes 053.12, 053.13, 053.19 or 729.2x in the period of 90 days to 12 months after the index date. Multivariable regression was used to compare HZ cases with matched controls after adjusting for demographic characteristics, insurance status, co-morbidities and medical expenditure in the 6 months prior to diagnosis for each of the endpoints. Separate regression models were developed, in which age and immune status were stratified. All costs were adjusted to March 2008 values using the medical care component of the Consumer Price Index. The average per patient cost of all HZ cases was $US605 in the first 90 days after diagnosis and $US1052 at 1 year. For the subset with PHN, the average per patient cost of HZ at 1 year was $US3815. For the subset with an immunocompromising condition, the average HZ cost at 1 year was $US1745. The majority of the costs were the result of outpatient visits and prescription drugs. The subset of HZ cases that had both absence hour and short-term disability (STD) records available had 26.5 absence hours and 2.9 STD days. Healthcare utilization, medical care costs and work loss all increased with age for all HZ cases. Based on the results from the present study, the direct medical cost burden of HZ in the US is high, exceeding $US1000 per HZ patient. This direct medical cost may be nearly twice as high in immunocompromised patients and four times as high in the subset of HZ cases with PHN. The direct medical cost burden of HZ may exceed $US1 billion annually in the US. The majority of medical RU and cost burden is incurred by the elderly. Although many people with HZ may no longer be in the workforce, HZ does contribute to lost work time.

Herpes zoster-attributable resource utilization and cost burden in patients with solid organ transplant.

OBJECTIVES: To evaluate health-care utilization and costs attributable to herpes zoster (HZ) within a population of patients with solid organ transplant (SOT). METHODS: Using administrative claims data, a commercially/Medicare-insured population of patients with SOT between January 1, 1999, and January 1, 2007, and a Medicaid population between January 1, 1999, and January 1, 2006, were identified. Each patient group was screened to select patients with claims of SOT with an incident diagnosis of HZ and continuous enrollment for the 6 months prior and 3 months subsequent to the incident HZ. Controls were selected from group of SOT patients without claims of HZ using a propensity score matching process. Descriptive analyses were performed to quantify health-care utilization and costs attributable to HZ. Multivariate analyses were used to estimate HZ-attributable costs adjusted by demographic and clinical variables. RESULTS: A total of 205 commercially/Medicare-insured matched pairs and 136 Medicaid matched pairs were selected. Mean age in the commercial/Medicare SOT-HZ population was 56.9 years, and that in the Medicaid population was 42.5 years. The majority of HZ patients were diagnosed within 2 years of evidence of SOT. The unadjusted differences in total HZ-attributable health-care costs were $4762 and $6705 for commercial/Medicare-insured and Medicaid patients, respectively (P=0.176 and P=0.003, respectively) and were largely driven by hospitalization costs. Adjusted incremental costs in the SOT-HZ commercial/Medicare-insured patients were $5335 (P<0.001), and that in noncapitated Medicaid patients were $3711 (P<0.001). CONCLUSION: The occurrence of HZ in patients immunocompromised by SOT significantly increased health-care utilization and costs.

Economic burden of herpes zoster among skilled nursing facility residents in the United States.

OBJECTIVES: To evaluate health care resource use and direct medical costs attributable to herpes zoster (HZ) among elderly residents of skilled nursing facilities (SNF). METHODS: This was a retrospective matched cohort study using data from 300 SNF in the United States. A total of 404 patients with HZ were matched with 1616 patients with no documented HZ or post-herpetic neuralgia using propensity scores. The study period included a 1-month pre-index period and the 90-day acute/subacute phase following the HZ index date. Health care resource utilization was captured from the long term care minimum dataset (MDS) and SNF admission-discharge records. The direct medical costs consisted of the SNF net bed revenue and hospitalization cost. RESULTS: Over the 4-month study period, significantly more patients were hospitalized among the HZ (20.5%) than non-HZ cohort (14.4%). Both the numbers of hospitalization episodes and hospitalization days were greater for HZ than for non-HZ patients. An average additional 0.09 hospitalization episodes and 0.55 days of hospitalization were estimated in a multivariate model for patients in the HZ compared with the non-HZ cohort. The incremental direct medical costs, which are composed of the incremental medical costs incurred in the SNF, and the incremental costs attributable to hospitalization, were estimated between $1079 and $1673 for patients with HZ. CONCLUSION: In the SNF setting, the presence of HZ imposes significant health care resource utilization and direct medical costs.