Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: a retrospective, population-based study

Leonardo Emberti Gialloreti, Monica Merito, Patrizio Pezzotti, Luigi Naldi, Antonio Gatti, Maud Beillat, Laurence Serradell, Rafaelle di Marzo, Antonio Volpi, Leonardo Emberti Gialloreti, Monica Merito, Patrizio Pezzotti, Luigi Naldi, Antonio Gatti, Maud Beillat, Laurence Serradell, Rafaelle di Marzo, Antonio Volpi

Abstract

Background: Data on the epidemiology and cost of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in Italy are limited. This retrospective, population-based study was designed to determine the incidence of HZ and the proportion developing PHN in Italy and the associated medical resource utilisation and costs. It focused primarily on immunocompetent patients aged > or = 50 years who would be eligible for preventive vaccination.

Method: Data were extracted from a primary-care database and national hospital-discharge records covering four major regions in Italy for 2003-2005. Cases of HZ and PHN (1 and 3 months' duration; PHN1 and PHN3) were identified by ICD9-CM codes and, additionally for PHN, prescription of neuropathic pain medication.

Results: Over 3 years, 5675 incident cases of HZ were documented in adults, of which 3620 occurred in immunocompetent patients aged > or = 50 years (incidence of 6.31 per 1000 person-years [95% CI: 6.01-6.62]). Of the immunocompetent patients aged > or = 50 years with HZ, 9.4% (95% CI: 8.2-10.7) and 7.2% (95% CI: 6.2-8.2) developed PHN1 and PHN3, respectively. Increasing age, female sex, and being immunologically compromised conferred increased risk for both HZ and PHN. Overall, about 1.3% of HZ and almost 2% of PHN cases required inpatient care, with 16.9% of all HZ-related hospitalisations due specifically to PHN. In patients aged > or = 50 years, mean stay was 7.8 +/- 5.4 days for HZ and 10.2 +/- 8.6 days for PHN, and direct costs associated with inpatient care were more than 20 times outpatient costs per HZ case (mean +/- SD: euro2592 +/- euro1313 vs. euro122.68 +/- euro97.51) and over 5 times more per episode of PHN (mean +/- SD: euro2806 +/- euro2641 vs. euro446.10 +/- euro442.97). Total annual costs were euro41.2 million, of which euro28.2 million were direct costs and euro13.0 million indirect costs.

Conclusions: This study, the largest to date on the epidemiology and economic impact of HZ and PHN in Italy, confirms the considerable disease and economic burden posed by HZ. As HZ and PHN disproportionately affect the elderly, without intervention this problem is likely to grow as the proportion of elderly in the Italian population continues to increase.

Figures

Figure 1
Figure 1
Incidence of HZ in the general adult (≥15 years) and immunocompetent adult populations in Italy.
Figure 2
Figure 2
Proportion of PHN in the general adult (≥15 years) and immunocompetent adult populations in Italy.
Figure 3
Figure 3
Age-related incidence of hospitalisation for HZ and PHN in immunocompetent adults in Italy.

References

    1. Bowsher D. The lifetime occurrence of herpes zoster and prevalence of postherpetic neuralgia: a retrospective survey in an elderly population. Eur J Pain. 1999;3:335–342. doi: 10.1016/S1090-3801(99)90015-0.
    1. Edmunds WJ, Brisson M, Rose JD. The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales. Vaccine. 2001;19:3076–3090. doi: 10.1016/S0264-410X(01)00044-5.
    1. Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, Roos L, De Serres G. Epidemiology of varicella zoster virus infection in Canada and in the United Kingdom. Epidemiol Infect. 2001;127:305–314. doi: 10.1017/S0950268801005921.
    1. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995;155:1605–1609. doi: 10.1001/archinte.155.15.1605.
    1. Levin MJ, Smith JG, Kaufhold RM, Barber D, Hayward AR, Chan CY, Chan IS, Li DJ, Wang W, Keller PM, Shaw A, Silber JL. Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis. 2003;188:1336–1344. doi: 10.1086/379048.
    1. Gauthier A, Breuer J, Carrington D, Martin M, Remy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137:38–47. doi: 10.1017/S0950268808000678.
    1. Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, MacIntyre CR. Herpes zoster burden of illness and health care resource utilization in the Australian population aged 50 years and older. Vaccine. 2009;27:520–529. doi: 10.1016/j.vaccine.2008.11.012.
    1. Yawn BP, Saddier P, Wollan PC, St. Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccination introduction. Mayo Clin Proc. 2007;82:1341–1349. doi: 10.4065/82.11.1341.
    1. Volpi A, Gatti A, Pica F, Bellino S, Marsella LT, Sabato AF. HYPERLINK " " Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol. 2008;80:1646–1652. doi: 10.1002/jmv.21254.
    1. Oster G, Harding G, Dukes E, Edelsberg J, Cleary P. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain. 2005;6:356–363. doi: 10.1016/j.jpain.2005.01.359.
    1. Katz J, Cooper E, Walther R, Sweeney E, Dworkin R. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004;39:342–348. doi: 10.1086/421942.
    1. Brisson M, Pellissier JM, Camden S, Quach C, De Wals P. The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia. Hum Vaccin. 2008;4:238–245.
    1. Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18:350–354. doi: 10.1097/00002508-200211000-00002.
    1. Schmader KE, Sloane R, Pieper C, Coplan PM, Nikas A, Saddier P, Chan I, Choo P, Levin MJ, Johnson G, Williams HM, Oxman MN. The impact of acute herpes zoster pain and discomfort on functional status and quality of life in older adults. Clin J Pain. 2007;23:490–496. doi: 10.1097/AJP.0b013e318065b6c9.
    1. Volpi A, Gross G, Hercogova J, Johnson RW. Current management of herpes zoster. The European view. Am J Clin Dermatol. 2005;6:317–325. doi: 10.2165/00128071-200506050-00005.
    1. Johnson RW, Wasner G, Saddier P, Baron R. Herpes zoster and postherpetic neuralgia: optimizing management in the elderly patient. Drugs Aging. 2008;25:991–1006. doi: 10.2165/0002512-200825120-00002.
    1. United Nations Population Division. World Population Prospects: The 2006 Revision Population Database. accessed 11 March 2009.
    1. Di Luzio Paparatti U, Arpinelli F, Visona G. Herpes zoster and its complications in Italy: an observational survey. J Infect. 1999;38:116–119. doi: 10.1016/S0163-4453(99)90079-8.
    1. Di Legami V, Gianino MM, Atti MCD, Massari M, Migliardi A, Tomba GS, Zotti C. Zoster Study Group. Epidemiology and costs of herpes zoster: background data to estimate the impact of vaccination. Vaccine. 2007;25:7598–7604. doi: 10.1016/j.vaccine.2007.07.049.
    1. Filippi A, Bignamini AA, Sessa E, Samani F, Mazzaglia G. Secondary prevention of stroke in Italy: a cross-sectional survey in family practice. Stroke. 2003;34:1010–1014. doi: 10.1161/01.STR.0000062888.90293.AA.
    1. Filippi A, Sabatini A, Badioli L, Samani F, Mazzaglia G, Catapano A, Cricelli C. Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behaviour among General Practitioners in Italy in diabetic patients: an intervention trial. Diabetes Care. 2003;26:1497–1500. doi: 10.2337/diacare.26.5.1497.
    1. Italian National Institute of Statistics (ISTAT) [HYPERLINK " "]; accessed 11 March 2009.
    1. Leyland AH, Goldstein H. Multilevel Modelling of Health Statistics. Chichester: Wiley; 2001.
    1. Italian Medicines Agency (Agenzia Italiana del Farmaco; AIFA) Prontuario Farmaceutico Nazionale (PFN). Italy. 2005.
    1. Consiglio Nazionale dell'Economia e del Lavoro, Banca dati su costo, retribuzioni e orario di lavoro. [HYPERLINK " " ]; accessed 11 March 2009.
    1. Chidiac C, Brucelle J, Daures J-P, Hoang-Xuan T, Morel P, Leplege A, El Hasnaoui A, de Labareyer C. Characteristics of patients with herpes zoster on presentation to practitioners in France. Clin Infect Dis. 2001;33:62–69. doi: 10.1086/320884.
    1. Fleming DM, Cross KW, Cobb WA, Chapman RS. Gender difference in the incidence of shingles. Epidemiol Infect. 2004;132:1–5. doi: 10.1017/S0950268803001523.
    1. Opstelten W, Van Essen GA, Schellevis F, Verheij TJM, Moons KGM. Gender as an independent risk factor for herpes zoster: a population-based prospective study. Ann Epidemiol. 2006;16:692–695. doi: 10.1016/j.annepidem.2005.12.002.
    1. Schmader K, Gorge LK, Burchett BM, Pieper CF, Hamilton JD. Racial differences in the occurrence of herpes zoster. J Infect Dis. 1995;171:701–704.
    1. Gross G, Schöfer H, Wassilew S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP, Wutzler P, Doerr HW. Herpes zoster guideline of the German Dermatology Society (DDG) J Clin Virol. 2003;26:277–289. doi: 10.1016/S1386-6532(03)00005-2.
    1. Oxman MN. In: Varicella-zoster Virus: Virology and Clinical Management. Arvin AM, Gershon AA, editor. Cambridge, UK: Cambridge University Press; 2000. Clinical manifestations of herpes zoster; pp. 246–275. full_text.
    1. Chen TM, Gorge S, Woodruff CA, Hsu S. Clinical manifestations of varicella-zoster virus infection. Dermatol Clin. 2002;20:267–282. doi: 10.1016/S0733-8635(01)00012-2.
    1. Choo PW, Galil K, Donahue JG, Walker AM, Spiegelman D, Platt R. Risk factors for post herpetic neuralgia. Arch Intern Med. 1997;157:1217–1224. doi: 10.1001/archinte.157.11.1217.
    1. Dworkin RH, Boon RJ, Griffin DR, Phung D. Postherpetic neuralgia: impact of famciclovir, age, rash severity and acute pain in herpes zoster patients. J Infect Dis. 1998;178(Suppl 1):76S–80S. doi: 10.1086/514260.
    1. Wood MJ, Kay R, Dworkin RH, Soong SJ, Whitley RJ. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis. 1996;22:341–347.
    1. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, Arbeit RD, Simberkoff MS, Gershon AA, Davis LE, Weinberg A, Boardman KD, Williams HM, Hongyuan Zhang J, Peduzzi PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA, Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, Brunell P, Soto NE, Marques AR, Keay SK, Goodman RP, Cotton DJ, Gnann JW, Loutit J, Holodniy M, Keitel WA, Crawford GE, Yeh S-S, Lobo Z, Toney JF, Greenberg RN, Keller PM, Harbecke R, Hayward AR, Irwin MR, Kyriakides TC, Chan CY, Chan ISF, Wang WWB, Annuziato PW, Silber JL. for the Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–2284. doi: 10.1056/NEJMoa051016.
    1. Brisson M, Edmunds WJ. Epidemiology of varicella-zoster virus in England and Wales. J Med Virol. 2003;70(Suppl 1):S9–S14. doi: 10.1002/jmv.10313.
    1. Gil A, San-Martin M, Carrasco P, Gonzales A. Epidemiology of severe varicella-zoster virus infection in Spain. Vaccine. 2004;22:3947–3951. doi: 10.1016/j.vaccine.2004.04.004.
    1. Scott FT, Johnson RW, Leedham-Green M, Davies E, Edmunds WJ, Breuer J. The burden of herpes zoster: A prospective population based study. Vaccine. 2006;24:1308–1314. doi: 10.1016/j.vaccine.2005.09.026.
    1. Opstelten W, van Essen GA, Mons KGM, van Wijck AJM, Schellevis FG, Kalkman CJ, Verheij TJM. Do herpes zoster patients receive antivirals? A Dutch national survey in general practice. Family Practice. 2005;22:523–528. doi: 10.1093/fampra/cmi055.
    1. Wood MJ, Shukla S, Fiddian AP, Crooks RJ. Treatment of acute herpes zoster: effect of early (<48 h) versus late (48-72 h) therapy with acyclovir and valacicolvir on prolonged pain. J Infect Dis. 1998;178(Suppl 1):S81–S84. doi: 10.1086/514271.
    1. Li Q, Chen N, Yang J, Zhou D, Zhang Q, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2009;2:CD006866.
    1. Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334:1211–1215. doi: 10.1136/.

Source: PubMed

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