Lifetime Medical Costs of Genital Herpes in the United States: Estimates From Insurance Claims

Abstract

Background:The purpose of this study was to estimate the lifetime direct medical costs per incident case of genital herpes in the United States. Methods:We used medical claims data to construct a cohort of people continuously enrolled in insurance for at least 48 consecutive months between 2010 and 2018. From this cohort, we identified initial genital herpes diagnoses as well as the cost of related clinical visits and medication during the 36 months after an initial diagnosis. Lifetime costs beyond 36 months were estimated based on treatment use patterns observed in the 36 months of follow-up. Results:The present value of lifetime direct medical costs of genital herpes was estimated to be $972 per treated case or $165 per infection (2019 dollars), not including costs associated with prevention or treatment of neonatal herpes. The clinical visit at which genital herpes was first diagnosed accounted for 27% of lifetime costs. Subsequent clinical visits and medications related to genital herpes accounted for an additional 13% and 60% of lifetime costs, respectively. Conclusions:The results from this study can inform cost-effectiveness analysis of genital herpes control interventions as well as help quantify the cost burden of sexually transmitted infections in the United States.

The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018

“…For genital herpes (attributed to HSV-2), the base case values for the estimated lifetime medical cost per infection for men and women were $156 and $169, respectively (Table 1). 12 A key assumption behind these estimates was that 17% of people with genital herpes would incur medical costs as a result of their infection 22 ; the remaining 83% would incur no medical costs. For those incurring medical costs, the average lifetime cost per diagnosed case of genital herpes was $920 for men and $996 for women, 12 based on medical claims data for a cohort of commercially insured individuals continuously enrolled for at least 4 years during 2010 to 2018.…”

“…19,20,[43][44][45][46] Second, for all STIs examined, with the exception of HBV, we obtained lifetime cost estimates from studies published in this Special Issue. [10][11][12][13]15 Because full articles were devoted to estimating the lifetime cost of a single STI or a group of related STIs, the methods, assumptions, and data sources have been described and documented in far more detail than previously. These STI-specific articles also allow for discussion of key STI-specific issues, such as the effect of HIV preexposure prophylaxis on the proportion of HIV infections attributable to STIs, 31 declines in the burden of HPV in the HPV vaccination era, 15,44 and potential increases in gonorrhea costs in the future due to increases in antimicrobial resistance.…”

“…19,20,[43][44][45][46] Similarly, estimates we applied of the lifetime medical cost per infection are limited by uncertainties regarding the cost of treatment, the probability of treatment or uptake of therapy, the probability and cost of sequelae, and other factors, as described in more details in the source articles. [10][11][12][13]15 We addressed these unavoidable limitations by calculating ranges for the estimated lifetime cost of STIs acquired in 2018, using an approach specifically designed to reflect the likely impact and magnitude of the effect of the uncertainty in the studies that informed our analysis.…”

“…Estimates of the number of incident infections in 2018 were obtained from the study by Kreisel and colleagues 9 in this Special Issue (Table 1). Estimates of the lifetime cost per infection were obtained from cost studies that follow in this Special Issue for chlamydia, 10 gonorrhea, 10 trichomoniasis, 10 syphilis, 11 genital herpes, 12 and HIV 13 (Tables 1 and 2). The inclusion of these cost studies in this Special Issue allows for a detailed description of the methods used to arrive at the estimated lifetime cost per infection for each of these STIs, along with extensive documentation of data sources and assumptions.…”

“…Given the availability of STI incidence estimates for 2018 9 and updated estimates of the average lifetime medical cost per infection, [10][11][12][13] our goal was to provide updated estimates of the medical cost burden of STIs. Specifically, we estimated the expected lifetime direct medical costs of STIs acquired in 2018 in the United States, including sexually acquired HIV.…”