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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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Age-related incidence of hospitalisation for HZ and PHN in immunocompetent adults in Italy.
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Figure 3: Age-related incidence of hospitalisation for HZ and PHN in immunocompetent adults in Italy.

Mentions: Over the 3-year study period, the average incidences of hospitalisation for primary diagnoses of HZ and PHN were 10.34 and 1.89 per 100,000 person-years, respectively, in immunocompetent patients aged ≥50 years. The total incidence rose to 20.31 per 100,000 person-years (17.45 for HZ and 2.86 for PHN) in this population when both primary and secondary diagnoses on SDOs were combined. Corresponding figures for the adult immunocompetent population as a whole were 5.55 per 100,000 person-years for a primary diagnosis (4.61 for HZ and 0.94 for PHN) and 9.60 per 100,000 person-years for primary and secondary diagnoses combined (7.94 for HZ and 1.66 for PHN). Within the older population, rates of hospitalisation increased progressively for each decade up to 85 years (Figure 3). Based on these figures, HZ or PHN as a primary diagnosis is responsible for 2829 hospitalisations annually in Italy among the immunocompetent adult population, of which 2611 (92.3%) admissions are in those aged ≥50 years. When primary and secondary diagnoses are combined, about 1.3% of HZ cases in Italy result in hospitalisation, rising to almost 2% where patients develop PHN. Overall, 16.9% of hospitalisations related to HZ were due specifically to PHN.


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)

Age-related incidence of hospitalisation for HZ and PHN in immunocompetent adults in Italy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Age-related incidence of hospitalisation for HZ and PHN in immunocompetent adults in Italy.
Mentions: Over the 3-year study period, the average incidences of hospitalisation for primary diagnoses of HZ and PHN were 10.34 and 1.89 per 100,000 person-years, respectively, in immunocompetent patients aged ≥50 years. The total incidence rose to 20.31 per 100,000 person-years (17.45 for HZ and 2.86 for PHN) in this population when both primary and secondary diagnoses on SDOs were combined. Corresponding figures for the adult immunocompetent population as a whole were 5.55 per 100,000 person-years for a primary diagnosis (4.61 for HZ and 0.94 for PHN) and 9.60 per 100,000 person-years for primary and secondary diagnoses combined (7.94 for HZ and 1.66 for PHN). Within the older population, rates of hospitalisation increased progressively for each decade up to 85 years (Figure 3). Based on these figures, HZ or PHN as a primary diagnosis is responsible for 2829 hospitalisations annually in Italy among the immunocompetent adult population, of which 2611 (92.3%) admissions are in those aged ≥50 years. When primary and secondary diagnoses are combined, about 1.3% of HZ cases in Italy result in hospitalisation, rising to almost 2% where patients develop PHN. Overall, 16.9% of hospitalisations related to HZ were due specifically to PHN.

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