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Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany

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Abstract

After acquiring a varicella virus infection, the virus can reactivate and cause herpes zoster (HZ)—a painful skin rash. A complication of HZ is long-term persistence of pain after the rash has resolved (so-called postherpetic neuralgia, PHN). We aimed to describe the epidemiology of HZ/PHN and to estimate HZ/PHN-related costs in the German statutory health insurance (SHI) system (~85 % of the total population). Treatment data of one large SHI was utilized, containing data on approximately 240,000 insured and their utilisation of services in 2004–2009. Identification of HZ- and PHN-cases was performed based on ‘International Statistical Classification of Diseases’ and specific medications using a control-group design. Incidences per 1,000 person-years (PY) and cost-of-illness for 1 year following HZ-onset considering the payer and societal perspective were calculated. All amounts were inflated to 2010 Euros. Population-figures were standardised and extrapolated to the total SHI-population in Germany in 2010. A mean annual incidence of 5.79 HZ-cases per 1,000 PY was observed, translating into an estimated 403,625 HZ-cases per year in the total SHI-population. Approximately 5 % of HZ-cases developed PHN. One HZ-case caused on average €210 and €376 of costs from the payer and societal perspective, respectively. The development of PHN generated additional costs of €1,123 (€1,645 societal perspective). Total annual HZ/PHN-related costs were estimated at €182 million (€105 million) to society (payer). HZ and PHN place a considerable burden on the German SHI-system. Since HZ-vaccines will soon be available, a health-economic evaluation of these vaccines should be conducted.

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Acknowledgements

The authors gratefully acknowledge the supporting consultancy of Dr. Andrej Rasch [Federal Joint Committee (G-BA)]. Furthermore, we would like to thank AOK Hesse, KV Hesse, and the Ministry of Social Affairs Hesse for the permission to access data. Funding for this study was provided fully by the Robert Koch Institute (FKZ 1362/1-983).

Conflict of interest

Before initiation of this research, B.U. was an employee of Sanofi Pasteur MSD (provider of a herpes zoster vaccine) from April 2008 to May 2010. I.K. and I.S. conducted a research project in 2007 that was fully funded by Sanofi Pasteur MSD. (provider of a herpes zoster vaccine).

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Authors and Affiliations

  1. Immunisation Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086, Berlin, Germany

    Bernhard Ultsch, Anette Siedler & Ole Wichmann

  2. Charité, University Medical Centre, Berlin, Germany

    Bernhard Ultsch

  3. PMV Research Group, University of Cologne, Cologne, Germany

    Ingrid Köster & Ingrid Schubert

  4. Institute for Social Medicine, Epidemiology and Health Economics, Charité, University Medical Centre, Berlin, Germany

    Thomas Reinhold

  5. Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

    Gérard Krause

  6. Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany

    Gérard Krause

  7. Institute for Biometry and Epidemiology at the German Diabetes-Center, Heinrich Heine University, Düsseldorf, Germany

    Andrea Icks

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  1. Bernhard Ultsch
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Ultsch, B., Köster, I., Reinhold, T. et al. Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany. Eur J Health Econ 14, 1015–1026 (2013). https://doi.org/10.1007/s10198-012-0452-1

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