Investigators Examine the Cost of Shingles to the Healthcare System

Around 30 percent of the population will experience herpes zoster (HZ), 10 percent of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system. Friesen, et al. (2017) analyzed administrative healthcare data collected over the period of April 1, 1997 to March 31, 2014 to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care and hospitalizations within each year.

The incidence of HZ increased by 49.5 percent from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14.

Drug costs rose significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to $127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p <0.0001) from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI; $74.08, $83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95% CI; $284, $511) to $195/episode (95% CI; $129, $260).

Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7 percent lower than the 1997/98 costs of $2,095,633.

The researchers concluded that a significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21 percent increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts. The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3 percent in the last four study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population.

Reference: Friesen KJ, et al. Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia. BMC Infectious Diseases. 2017;17:69