Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States

Li, Qian; Chen, Shih Yin; Burstin, Stuart J.; Levin, Myron J.; Suaya, José A.

doi:10.1093/ofid/ofw067

Cited by 15 publications

(25 citation statements)

References 19 publications

(31 reference statements)

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“…Relative to drug consumption, our findings confirm the expected increase of antiviral drugs used in the HZ treatment, drugs used in the postherpetic neuralgia, and drugs used in the pain treatment in HZ cohort [34][35][36].…”

Section: Discussionsupporting

confidence: 75%

The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years

et al. 2020

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The effect of severe Herpes Zoster (HZ) on chronic diseases is a component of the real burden of this vaccine-preventable disease that is not commonly considered. A retrospective cohort study was conducted to assess the health burden of severe HZ in adults ≥50 years residing in Liguria Region from 2015 to 2017. Subjects hospitalized with and without HZ were matched (1:6 ratio). 437 subjects in the HZ cohort and 2622 subjects in the non-HZ cohort were enrolled. Previous immunodeficiency, autoimmune, and rare diseases are identified as main chronic conditions related to HZ hospitalization. Higher incidences of autoimmune (1.4% vs. 0.22%, p = 0.002) and gastrointestinal (7.04% vs. 3.62%, p = 0.015) diseases after hospitalization were observed in the HZ cohort compared to the non-HZ cohort. Significantly higher incidences were found after hospitalization versus the previous period for cardiovascular diseases (11.17% vs. 2.09%, p < 0.001), cerebral vasculopathy (6.13% vs. 0.60%, p < 0.001), non-arrhythmic myocardiopathy (4.31% vs. 0.59%, p = 0.002), and neuropathy (2.62% vs. 0.56%, p = 0.033). The HZ cohort showed a relative risk 10-fold higher for cerebral vasculopathy, 5-fold higher for cardiovascular diseases, and 7-fold higher for non-arrhythmic myocardiopathy. HZ causes a substantial impact on the chronic conditions. These data could suggest an implementation of HZ vaccination programs in the elderly and in high-risk groups.

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Section: Discussionsupporting

confidence: 75%

The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years

et al. 2020

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“…Recipients of HSCT have both an increased incidence and severity of HZ [5][6][7]11,12]. In this trial, the overall efficacy of RZV in preventing HZ cases in autologous HSCT recipients was 68.2% (95% CI, 55.6% to 77.5%) [21].…”

Section: Discussionmentioning

confidence: 79%

“…Hematopoietic stem cell transplantation is the risk factor with the highest odds ratio for developing HZ (odds ratio, 13.46) [5]. Several studies reported an increased risk of HZ among stem cell transplant recipients, with incidence rates reaching 41.7 per 1000 person years [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Recombinant Zoster Vaccine Significantly Reduces the Impact on Quality of Life Caused by Herpes Zoster in Adult Autologous Hematopoietic Stem Cell Transplant Recipients: A Randomized Placebo-Controlled Trial (ZOE-HSCT)

Curran

Matthews

Rowley

et al. 2019

Biology of Blood and Marrow Transplantation

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Herpes zoster (HZ) can have a substantial impact on quality of life (QoL). The vaccine efficacy (VE) of a recombinant zoster vaccine (RZV) was 68.2% (95% confidence interval [CI], 55.6% to 77.5%) in a phase 3 study in adult autologous hematopoietic stem cell transplant (HSCT) recipients (NCT01610414). Herein, we report the impact of RZV on patients' QoL. Autologous HSCT recipients were randomized 1:1 to receive 2 doses of RZV or placebo, given 1 to 2 months apart. QoL was measured by the Short Form Survey-36 and Euro-QoL-5 Dimension at baseline, 1 month, and 1 year postdose 2 and during suspected HZ episodes with the Zoster Brief Pain Inventory (ZBPI). The RZV impact

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“…These patients had relatively high recurrence rates, but many patients were not restarted on antiviral prophylaxis, and no guidelines address this issue. Alternative approaches to a durable antiviral prophylaxis strategy after autologous HCT are warranted given the high burden of late HZ, its associated morbidity, and increased healthcare utilization and costs among affected patients 22 . The currently available live attenuated varicella vaccines have been shown to be effective when given at two years post-HCT 36 , and guidelines allow the use of the zoster vaccine following autologous HCT in select recipients 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite that the number of autologous HCTs exceeds that of allogeneic HCTs 21 , there is a relative lack of contemporary data regarding the epidemiology of HZ after autologous HCT and the impact of VZV prophylaxis in this population. Recent findings of substantially increased healthcare costs and utilization among cancer and HCT patients with HZ lends additional support to the need for such data 22 .…”

Section: Introductionmentioning

confidence: 86%

Herpes Zoster in Autologous Hematopoietic Cell Transplant Recipients in the Era of Acyclovir or Valacyclovir Prophylaxis and Novel Treatment and Maintenance Therapies

Sahoo

Hill

Leisenring

et al. 2017

Biology of Blood and Marrow Transplantation

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The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir/valacyclovir (ACV/VACV) prophylaxis, is not well described. In this observational study from 2002–2010, we retrospectively identified 1,000 varicella zoster virus (VZV) seropositive autologous HCT recipients with up to five years of follow up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of five years post-autologous HCT, 194 patients developed at least one HZ episode with a cumulative incidence of 21%; 159/194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31/194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], 0.59; 95% CI, 0.37–0.91), whereas those older than the median age (≥55.5 years) had increased risk (aHR 1.42, 95% CI 1.05–1.9). Disseminated VZV was reported in 8% and post-herpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.

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Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States

Abstract: Among patients with common immune-compromised (IC) conditions in the United States, the healthcare cost associated with herpes zoster (HZ) was sizable and occurred mainly during the first quarter after diagnosis. And HZ-associated costs varied by age and underlying IC conditions.

Cited by 15 publications

References 19 publications

The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years

The Unknown Health Burden of Herpes Zoster Hospitalizations: The Effect on Chronic Disease Course in Adult Patients ≥50 Years

Recombinant Zoster Vaccine Significantly Reduces the Impact on Quality of Life Caused by Herpes Zoster in Adult Autologous Hematopoietic Stem Cell Transplant Recipients: A Randomized Placebo-Controlled Trial (ZOE-HSCT)

Herpes Zoster in Autologous Hematopoietic Cell Transplant Recipients in the Era of Acyclovir or Valacyclovir Prophylaxis and Novel Treatment and Maintenance Therapies

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