Meyers JL, Candrilli SD, Rausch DA, Yan S, Patterson BJ, Levin MJ. Costs of herpes zoster complications in older adults: a cohort study of US claims database. Vaccine. 2019 Feb 21;37(9):1235-44. doi: 10.1016/j.vaccine.2018.11.079

BACKGROUND/OBJECTIVES: Herpes zoster (HZ) incidence increases with age and with aging populations worldwide the burden of HZ is expected to grow. We aim to determine the incremental healthcare resource utilization and associated costs of patients with HZ-related complications other than postherpetic neuralgia; i.e., cutaneous, neurologic and ophthalmic complications, compared to uncomplicated HZ.

METHODS: 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 of patients 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. Multivariate regression analyses estimated mean incremental costs adjusted for demographics, comorbidities, type of complication and time period.

RESULTS: 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$4,716, ranging from US$2,173 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.

CONCLUSIONS: Approximately 10% of immunocompetent older patients with HZ develop complications which considerably increase the economic burden of HZ. Vaccination of older adults may offset some of the burden of disease, including costs associated with HZ-related complications.

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