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

Gialloreti LE, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, Serradell L, di Marzo R, Volpi A - BMC Infect. Dis. (2010)

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dipartimento di Sanità Pubblica, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Roma, Italy. leonardo.emberti.gialloreti@uniroma2.it

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.

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Incidence of HZ in the general adult (≥15 years) and immunocompetent adult populations in Italy.
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Figure 1: Incidence of HZ in the general adult (≥15 years) and immunocompetent adult populations in Italy.

Mentions: In total, 5675 incident cases of HZ were documented over the 3-year study period, with 1843, 1898 and 1934 cases recorded in 2003, 2004 and 2005, respectively. Patients aged ≥50 years accounted for 4119 (72.6%) incident cases, of which 3620 (87.9%) occurred in immunocompetent patients. Among men and women aged ≥50 years, this corresponded to an incidence of 6.65 per 1000 person-years (95% CI: 6.35-6.97), or 6.31 per 1000 person-years (95% CI: 6.01-6.62) in the immunocompetent population. In comparison, the incidence was 4.31 per 1000 person-years (95% CI: 4.11-4.52) for the adult population as a whole, or 4.07 per 1000 person-years (95% CI: 3.88-4.27) for the immunocompetent adult population. Incidence increased markedly with age, with the peak occurring in those aged 75-79 years (Figure 1). HZ was more common among women than men in the total population, with an incidence of 4.75 (95% CI: 4.47-5.03) compared with 3.82 (95% CI: 3.62-4.03) per 1000 person-years, respectively.


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

Gialloreti LE, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, Serradell L, di Marzo R, Volpi A - BMC Infect. Dis. (2010)

Incidence of HZ in the general adult (≥15 years) and immunocompetent adult populations in Italy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2921387&req=5

Figure 1: Incidence of HZ in the general adult (≥15 years) and immunocompetent adult populations in Italy.
Mentions: In total, 5675 incident cases of HZ were documented over the 3-year study period, with 1843, 1898 and 1934 cases recorded in 2003, 2004 and 2005, respectively. Patients aged ≥50 years accounted for 4119 (72.6%) incident cases, of which 3620 (87.9%) occurred in immunocompetent patients. Among men and women aged ≥50 years, this corresponded to an incidence of 6.65 per 1000 person-years (95% CI: 6.35-6.97), or 6.31 per 1000 person-years (95% CI: 6.01-6.62) in the immunocompetent population. In comparison, the incidence was 4.31 per 1000 person-years (95% CI: 4.11-4.52) for the adult population as a whole, or 4.07 per 1000 person-years (95% CI: 3.88-4.27) for the immunocompetent adult population. Incidence increased markedly with age, with the peak occurring in those aged 75-79 years (Figure 1). HZ was more common among women than men in the total population, with an incidence of 4.75 (95% CI: 4.47-5.03) compared with 3.82 (95% CI: 3.62-4.03) per 1000 person-years, respectively.

Bottom Line: 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).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dipartimento di Sanità Pubblica, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Roma, Italy. leonardo.emberti.gialloreti@uniroma2.it

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.

Show MeSH
Related in: MedlinePlus