Herpes zoster and its serious complication, post-herpetic neuralgia, are frequent among people aged ≥ 60 years. |
This study investigated the economic burden of herpes zoster and post-herpetic neuralgia in Japanese patients aged ≥ 60 years: direct medical, non-medical, and indirect costs were examined. |
Outpatient visits and prescription medications were responsible for the majority of direct medical costs. |
This is the first investigation of the economic burden of herpes zoster and post-herpetic neuralgia in Japan. |
1 Introduction
2 Methods
2.1 Study Design
2.2 Data Collection
2.3 Cost Estimation
2.4 Complying with Ethics of Experimentation
3 Results
3.1 Patient Demographics
Age group (years) | 60–64
N = 92 | 65–69
N = 85 | 70–79
N = 163 | ≥ 80
N = 72 | Total
N = 412 | |||||
---|---|---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % |
n
| % |
n
| % | |
Gender | ||||||||||
Male | 40 | 43.5 | 34 | 40.0 | 65 | 39.9 | 25 | 34.7 | 164 | 39.8 |
Female | 52 | 56.5 | 51 | 60.0 | 98 | 60.1 | 47 | 65.3 | 248 | 60.2 |
Occupation | ||||||||||
Employed: full-time | 35 | 38.0 | 10 | 11.8 | 11 | 6.7 | 1 | 1.4 | 57 | 13.8 |
Employed: part-time | 8 | 8.7 | 10 | 11.8 | 4 | 2.5 | 0 | 0 | 22 | 5.3 |
Self-employed | 6 | 6.5 | 3 | 3.5 | 6 | 3.7 | 1 | 1.4 | 16 | 3.9 |
Not employed (housewife/unemployed/retired) | 42 | 45.7 | 57 | 67.1 | 137 | 84.0 | 66 | 91.7 | 302 | 73.3 |
Others | 1 | 1.1 | 3 | 3.5 | 1 | 0.6 | 0 | 0 | 5 | 1.2 |
Data not available | 0 | 0 | 2 | 2.4 | 4 | 2.5 | 4 | 5.6 | 10 | 2.4 |
Residence | ||||||||||
Kushiro | 77 | 83.7 | 74 | 87.1 | 138 | 84.7 | 63 | 87.5 | 352 | 85.4 |
Outside Kushiro | 15 | 16.3 | 11 | 12.9 | 25 | 15.3 | 9 | 12.5 | 60 | 14.6 |
Complicationsa
| ||||||||||
No complication | 83 | 90.2 | 73 | 85.9 | 126 | 77.3 | 58 | 80.6 | 340 | 82.5 |
Dermatological | 3 | 3.3 | 3 | 3.5 | 13 | 8.0 | 2 | 2.8 | 19 | 4.6 |
Ocular | 0 | 0 | 0 | 0 | 5 | 3.1 | 1 | 1.4 | 6 | 1.5 |
Neurological | 1 | 1.1 | 2 | 2.4 | 10 | 6.1 | 3 | 4.2 | 16 | 3.9 |
PHN | 5 | 5.4 | 7 | 8.2 | 20 | 12.3 | 6 | 8.3 | 38 | 9.2 |
3.2 Direct Medical Cost
Age group (years) | 60–64
N = 92 | 65–69
N = 85 | 70–79
N = 163 | ≥80
N = 72 | Total
N = 412 |
---|---|---|---|---|---|
Outpatient visit | |||||
n
| 92 | 85 | 163 | 72 | 412 |
Frequency (days) | 4.8 | 4.8 | 6.1 | 7.1 | 5.7 |
Mean cost [¥] | 5562 | 5507 | 6408 | 7293 | 6188 |
Hospitalization | |||||
n
a
| 0 | 2 | 6 | 0 | 8 |
Days/event | – | 8.5 | 9.7 | – | 9.4 |
Mean cost [¥] | 215,980 | 238,869 | 233,146 | ||
Medications/Prescriptions | |||||
n
| 92 | 85 | 163 | 72 | 412 |
Mean cost [¥] | 24,252 | 27,257 | 27,690 | 25,307 | 26,416 |
Injections | |||||
n
| 45 | 34 | 86 | 41 | 206 |
Frequency (times) | 5.0 | 4.8 | 5.9 | 6.7 | 5.7 |
Mean cost [¥] | 2637 | 2638 | 3462 | 3499 | 3153 |
Ointment treatment | |||||
n
| 46 | 39 | 76 | 40 | 201 |
Frequency (times) | 2.1 | 2.2 | 2.5 | 3.5 | 2.5 |
Mean cost [¥] | 1679 | 1659 | 2043 | 2937 | 2063 |
Other procedures | |||||
n
| 65 | 61 | 134 | 60 | 320 |
Mean cost [¥] | 5156 | 4927 | 5493 | 6048 | 5421 |
Category | Total
N = 412 | Medication | Total
N = 412 | ||
---|---|---|---|---|---|
n
| % |
n
| % | ||
Injections | 206 | 50.0 | An extract from cutaneous tissue of rabbit inoculated with vaccinia virus | 206 | 50.0 |
Glycyrrhizin/glycine/cysteine | 45 | 10.9 | |||
Ointment treatmentb
| 201 | 48.8 | Vidarabine | 141 | 34.2 |
Betamethasone valerate/gentamicin sulfate | 50 | 12.1 | |||
Prescriptionc
| |||||
Antivirals | 401 | 97.3 | Valaciclovir hydrochloride | 264 | 64.1 |
Vidarabine | 202 | 49.0 | |||
Famciclovir | 128 | 31.1 | |||
Analgesics | 277 | 67.2 | Acetaminophen | 208 | 50.5 |
Pregabalin | 133 | 32.3 | |||
Drugs for acid-related disorders | 217 | 52.7 | Rebamipide | 168 | 40.8 |
Sodium gualenate hydrate/L-glutamine | 40 | 9.7 | |||
Topical products for joint and muscular pain | 147 | 35.7 | Naproxen | 116 | 28.2 |
Vitamin B12 and folic acid | 138 | 33.5 | Mecobalamin | 138 | 33.5 |
Other dermatological preparations | 112 | 27.2 | Dimethyl isopropylazulene + bacitracin/fradiomycin sulfate | 67 | 16.3 |
Bacitracin/fradiomycin sulfate | 45 | 10.9 | |||
Dimethyl isopropylazulene | 42 | 10.2 | |||
Anti-inflammatory and antirheumatic products | 111 | 26.9 | Loxoprofen sodium hydrate | 72 | 17.5 |
Suprofen | 44 | 10.7 | |||
Corticosteroids, dermatological preparations | 78 | 18.9 | Betamethasone valerate/gentamicin sulfate | 70 | 17.0 |
All other therapeutics | 58 | 14.1 | An extract from cutaneous tissue of rabbit inoculated with vaccinia virus | 25 | 6.1 |
Aconic acid | 19 | 4.6 | |||
Goreisan | 16 | 3.9 | |||
Vitamins | 53 | 12.9 | Octotiamine/B2/B6/B12
| 46 | 11.2 |
3.3 Direct Non-Medical Cost
3.4 Indirect Cost
Age group (years) | 60–64
N = 92 | 65–69
N = 85 | 70–79
N = 163 | ≥80
N = 72 | Total
N = 412 |
---|---|---|---|---|---|
Patients | |||||
N
| 11 | 8 | 9 | 0 | 28 |
Mean (SD) | 4.8 (4.00) | 6.4 (13.26) | 12.0 (11.78) | - | 7.6 (10.13) |
Caregivers | |||||
N
| 5 | 6a
| 14 | 15 | 40b
|
(1) Paid employment | 3 | 4 | 5 | 8 | 20 |
Mean (SD) | 3.0 (2.65) | 10.5 (10.34) | 6.8 (10.31) | 5.5 (5.68) | 6.5 (7.59) |
(2) Unpaid employment | 1 | 3 | 3 | 2 | 9 |
Mean (SD) | 1.0 | 7.3 (5.13) | 25.3 (30.83) | 2.5 (0.71) | 11.6 (18.88) |
(3) Missing | 1 | 0 | 6 | 5 | 12 |
Mean (SD) | 1.0 | - | 11.2 (8.93) | 13.6 (23.75) | 11.3 (15.92) |
3.5 Total Costs from a Payer/Societal Perspective
Age group (years) | 60–64
N = 92 | 65–69
N = 85 | 70–79
N = 163 |
≥80
N = 72 | Total
N = 412 | |
---|---|---|---|---|---|---|
(1) Payer perspective (direct medical cost) | ||||||
HZ without any complications |
n
| 83 | 73 | 126 | 58 | 340 |
Mean | 32,274 | 36,615 | 38,414 | 33,853 | 35,751 | |
SD | 16,380 | 35,418 | 25,151 | 20,418 | 25,319 | |
Min | 13,710 | 13,376 | 4322 | 10,240 | 4322 | |
Median | 29,553 | 31,182 | 33,602 | 30,081 | 31,411 | |
Max | 139,712 | 247,457 | 215,379 | 132,270 | 247,457 | |
HZ with PHN |
n
| 5 | 7 | 20 | 6 | 38 |
Mean | 88,801 | 123,988 | 82,502 | 113,304 | 95,836 | |
SD | 66,197 | 147,992 | 74,362 | 60,806 | 87,560 | |
Min | 25,649 | 43,718 | 19,176 | 56,670 | 19,176 | |
Median | 60,233 | 64,067 | 62,267 | 85,235 | 65,562 | |
Max | 165,752 | 456,700 | 316,097 | 213,581 | 456,700 | |
HZ with complications, no PHN |
n
| 4 | 5 | 17 | 8 | 34 |
Mean | 37,795 | 26,184 | 99,415 | 40,965 | 67,643 | |
SD | 4537 | 14,353 | 128,667 | 44,177 | 97,614 | |
Min | 33,542 | 10,347 | 19,294 | 16,563 | 10,347 | |
Median | 36,718 | 22,704 | 41,061 | 29,202 | 33,793 | |
Max | 44,203 | 49,185 | 463,330 | 148,719 | 463,330 | |
Overall |
n
| 92 | 85 | 163 | 72 | 412 |
Mean | 35,586 | 43,197 | 50,186 | 41,264 | 43,925 | |
SD | 24,513 | 56,993 | 57,120 | 35,650 | 48,321 | |
Min | 13,710 | 10,347 | 4322 | 10,240 | 4322 | |
Median | 30,568 | 31,581 | 34,044 | 30,574 | 32,755 | |
Max | 165,752 | 456,700 | 463,330 | 213,581 | 463,330 | |
(2) Societal perspective (direct medical cost, direct non-medical cost, and indirect cost) | ||||||
HZ without any complications |
n
| 83 | 73 | 126 | 58 | 340 |
Mean | 39,941 | 48,396 | 46,110 | 49,373 | 45,652 | |
SD | 29,068 | 80,806 | 39,621 | 62,499 | 53,281 | |
Min | 13,974 | 13,442 | 4608 | 10,328 | 4608 | |
Median | 32,961 | 33,371 | 34,144 | 34,557 | 33,872 | |
Max | 149,011 | 652,800 | 237,256 | 430,560 | 652,800 | |
HZ with PHN |
n
| 5 | 7 | 20 | 6 | 38 |
Mean | 106,829 | 137,577 | 151,754 | 145,163 | 142,190 | |
SD | 75,642 | 152,751 | 159,415 | 81,126 | 136,255 | |
Min | 25,759 | 48,278 | 23,487 | 58,470 | 23,487 | |
Median | 78,387 | 76,507 | 72,088 | 125,965 | 80,290 | |
Max | 213,052 | 480,373 | 602,806 | 259,919 | 602,806 | |
HZ with complications, no PHN |
n
| 4 | 5 | 17 | 8 | 34 |
Mean | 45,788 | 45,145 | 103,093 | 55,495 | 76,630 | |
SD | 12,438 | 55,188 | 131,858 | 57,734 | 101,265 | |
Min | 36,674 | 10,479 | 19,426 | 18,954 | 10,479 | |
Median | 41,512 | 22,902 | 46,561 | 34,303 | 37,081 | |
Max | 63,454 | 143,201 | 483,130 | 188,319 | 483,130 | |
Overall |
n
| 92 | 85 | 163 | 72 | 412 |
Mean | 43,830 | 55,549 | 65,016 | 58,036 | 57,112 | |
SD | 35,355 | 89,555 | 85,252 | 68,055 | 75,138 | |
Min | 13,974 | 10,479 | 4608 | 10,328 | 4608 | |
Median | 33,609 | 34,062 | 36,982 | 35,560 | 35,229 | |
Max | 213,052 | 652,800 | 602,806 | 430,560 | 652,800 |