Shingles in Alberta: Before and after publicly funded varicella vaccination

Russell, Margaret L.; Dover, Douglas C.; Simmonds, Kimberley; Svenson, Lawrence W.

doi:10.1016/j.vaccine.2013.09.018

Cited by 50 publications

(79 citation statements)

References 15 publications

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“…A study published using data from Alberta, Canada also found an increase in the rates of HZ. However, they reported that this trend preceded the introduction of the VZ vaccine [39]. Another Canadian study looking at this same issue in Ontario found no increase in HZ rates [40].…”

Section: Discussionmentioning

confidence: 99%

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

et al. 2017

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BackgroundAround 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system.MethodsAdministrative healthcare data collected over the period of April 1st 1997 to March 31st 2014 were analyzed to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care, and hospitalizations within each year.ResultsThe incidence of HZ increased by 49.5% from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14.Drug costs rose significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to $127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p <0.0001) from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI; $74.08, $83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95% CI; $284, $511) to $195/episode (95% CI; $129, $260).Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7% lower than the 1997/98 costs of $2,095,633.ConclusionA significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21% increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts.The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3% in the last 4 study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population.

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Section: Discussionmentioning

confidence: 99%

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

et al. 2017

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“…We were able to capture all vaccination events and medically attended seizure events for the entire population, thus avoiding the sampling bias that may occur with private health insurance data sources, which often exclude lower-income individuals. 27,28 Although our study did not capture seizures for which no medical care was sought, we think it likely that most seizure events in children under the age of 2 years would cause sufficient parental concern to prompt access of health care services. Also, although we did not conduct chart reviews to confirm febrile seizures, seizure events were measured consistently both before and after vaccination for the 2 vaccine types, so calculation of the RRs should have been unbiased.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Risk of febrile seizures after first dose of measles–mumps–rubella–varicella vaccine: a population-based cohort study

MacDonald

Dover

Simmonds

et al. 2014

CMAJ

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“…Other studies have found an increasing incidence of HZ in the United States and other countries, consistent with our findings. 2,[18][19][20][21] The cause for this elevation in disease burden is unclear and is likely multifactorial. The age-specific increased rate of HZ-related ED visits in patients aged 20 to 59 years may be explained in part by the Hope-Simpson hypothesis that increased varicella zoster virus vaccination has led to a rise in overall HZ incidence.…”

Section: Discussionmentioning

confidence: 99%

Trends in Nationwide Herpes Zoster Emergency Department Utilization From 2006 to 2013

2017

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IMPORTANCEThe effect of vaccination on emergency department (ED) utilization for herpes zoster (HZ) has not been examined to date.OBJECTIVE To determine trends in US ED utilization and costs associated with HZ. DESIGN, SETTING, AND PARTICIPANTSThe Nationwide Emergency Department Sample data set was examined for temporal trends in the number of visits and costs for treatment of HZ in EDs in the United States from January 1, 2006, through December 31, 2013. Cases of HZ were identified using validated International Classification of Diseases, Ninth Revision-Clinical Modification diagnosis codes. Patients were stratified by age: less than 20 years (varicella vaccine recommended), 20 to 59 years (no vaccine recommended), and 60 years or older (HZ vaccine recommended). Population-based rates were estimated using sampling weights. MAIN OUTCOMES AND MEASURESPopulation-based incidence rates of HZ-related ED visits, charge for ED services, and total charges. RESULTS A total of 1 350 957 ED visits for HZ were identified between 2006 and 2013, representing 0.13% of all US ED visits. Of these patients, 563 200 (51.7%) were male; mean (SE) age was 54.0 (0.1) years. Between 2006 and 2013, the percentage of HZ-related ED visits increased from 0.13% to 0.14% (8.3%). This growth was driven by patients aged 20 to 59 years (increase of 22.8% [from 0.12% to 0.14% of ED visits]) while the proportion of ED HZ visits decreased for patients aged less than 20 years and 60 years or older, from 0.03% to 0.02% (−39.6%) and from 0.28% to 0.25% (−10.9%), respectively. For all age groups, there

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Shingles in Alberta: Before and after publicly funded varicella vaccination

Cited by 50 publications

References 15 publications

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

Risk of febrile seizures after first dose of measles–mumps–rubella–varicella vaccine: a population-based cohort study

Trends in Nationwide Herpes Zoster Emergency Department Utilization From 2006 to 2013

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