Acta Dermato-Venereologica 99-6CompleteContent | Page 23

616 SHORT COMMUNICATION Economic Analysis of Herpes Zoster in a Hospital Setting in Hong Kong Wai-kit MING 1,2 , Wing-yin YU 1 , Owen Tak-yin TSANG 3 , Paul Kay-sheung CHAN 4 and Joyce Hoi-sze YOU 1 School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, 2 Harvard Medical School, Harvard University, Boston, Massachusetts, USA, 3 Department of Medicine & Geriatrics, The Princess Margaret Hospital, Hospital Authority, and 4 Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. E-mail: [email protected] 1 Accepted Jan 16, 2019; E-published Jan 17, 2019 Both old age and female sex are well-recognized risk factors in herpes zoster (HZ), and the rate of HZ-related hospitalization is also associated with age (1, 2). Hospi- talization costs in Taiwan in 2006 were estimated as USD 1,427 per case of HZ (3). More than 50% of the Hong Kong population are female and 40% are 50 years or older (4). With an ageing population, the disease burden of HZ in Hong Kong is expected to increase. Zoster vaccine is reported to be effective and safe in pre- venting HZ in adults aged 50 years and above (5, 6), yet it is not included in the current public vaccination programme in Hong Kong. The direct medical cost of treatment of patients hospitalized with HZ is a crucial factor in examining the potential health economic benefits of zoster vaccine against HZ incidence and HZ-related hospitalization. The present study therefore analysed the direct medical costs of HZ in older adult patients in the hospital setting. METHODS using backward stepwise logistic models. The odds ratios with 95% confident interval (OR 95% CI) of significant predictors on high cost were reported. A p-value < 0.05 was considered statis- tically significant. RESULTS A total of 105 cases was reviewed, and 15 (14%) were immunocompromised patients (Table I). The age of im- munocompromised (64  ±  10 years) and immunocompetent (71  ±  11 years) patients were not significantly different. Of 15 immunocompromised patients, use of immune- suppressant/high-dose corticosteroid was the common underlying cause. The incidence of HZ-related complication (≥ 1 com- plication) was high in both immunocompromised (67%) and immunocompetent (43%) patients. Comparing with immunocompetent cases, higher rates of disseminated HZ (7% vs. 0%; p = 0.01) and HZ-related nervous system com- plications (13% vs. 1%; p = 0.009) occurred in the immu- nocompromised group. The hospital LOS was also longer in immunocompromised patients (14.7  ±  14.3 days) than in the immunocompetent group (5.9  ±  7.9 days) (p < 0.001). The mean total direct medical cost of hospitalized cases (n = 105) was USD 4,883  ±  6,271 (USD 1=HKD 7.8). The A retrospective observational study was conducted in 2 tertiary hospitals of Hong Kong. Patients aged 50 years or older with discharge diagnosis of HZ during the period between 1 January 2011 and 31 December 2013 were included. Patient demogra­phics and utilization of healthcare resources for HZ were retrieved from medical records. The resource items were hospital length of stay (LOS), diagnostic tests, drug treatment for Table I. Patient demographics, zoster-related complications and direct HZ and HZ-related complications. The study protocol cost for hospitalized cases of herpes zoster (HZ) was approved by the Joint Chinese University of Hong Immuno­ Immuno­ Kong–New Territories East Cluster Clinical Research All patients compromised competent Ethics Committee and the Kowloon West Cluster Clinical (n  = 105) (n  = 15) (n  = 90) p-value a Research Ethics Committee. Age, years, mean  ±  SD 70.2  ±  11.4 64.3  ±  10.0 71.2  ±  11.4 0.63 The cost analysis was conducted with 2018 costs from Male, n (%) 50 (47.6) 8 (53) 42 (47) 0.03 the perspective of the public healthcare provider in Hong Comorbidity, n (%) Cardiovascular disease b 68 (64.8) 10 (67) 58 (64) 0.87 Kong. The Hospital Authority is non-profit making and Diabetes mellitus 29 (27.6) 3 (20) 26 (29) 0.48 subsidized by the government, and the hospitalization 7 (6.7) 1 (7) 6 (7) 1.00 Respiratory disease c charge billed to non-Hong Kong residents was therefore Herpes zoster (HZ) complication, n (%) assumed to represent the cost of healthcare services. The One or more complication(s) 49 (47) 10 (67) 39 (43) 0.09 daily charges to non-Hong Kong residents for the general Post-herpetic neuralgia 41 (39) 8 (53) 33 (37) 0.22 medical ward (USD 654 per day) and intensive care unit HZ ophthalmicus 7 (7) 0 (0) 7 (8) 0.26 (USD 3,128 per day) were found in the Fees and Charges Disseminated HZ 1 (1) 1 (7) 0 (0) 0.01 Nervous system 3 (3) 2 (13) 1 (1) 0.009 list (7), and the unit cost of medication and laboratory tests Ramsay Hunt syndrome 2 (2) 1 (7) 1 (1) 0.15 were obtained from the study hospitals. Meningitis encephalitis 1 (1) 1 (7) 0 (0) 0.01 Data analysis was conducted with Microsoft Excel 2017 Length of stay, days, mean  ±  SD 7.1  ±  9.5 14.7  ±  14.3 5.9  ±  7.9 < 0.001 (Microsoft Corporation, Redmond, USA) and SPSS 16.0 Cost (USD) d , mean  ±  SD (SPSS Inc., Chicago, USA) for Windows. Continuous va- Laboratory 38  ±  66 46  ±  66 37  ±  66 0.63 riables were compared by analysis of variance (ANOVA), Medication 55  ±  85 69  ±  121 41  ±  71 < 0.001 Hospitalization 4,792  ±  6,236 9,713  ±  9,355 3,971  ±  5,187 < 0.001 and Pearson’s χ 2 test was used for comparison of binary Total direct medical cost 4,883  ±  6,271 9,891  ±  9,383 4,049  ±  5,212 < 0.001 variables. To determine predictors of high treatment cost a (defined as ≥ 75 th percentile of total direct medical cost), p-value for comparison of immunocompromised group vs. immunocompetent group. b Cardiovascular diseases included congestive heart failure, dyslipidaemia, hypertension, univariate analysis was performed on demographic and ischaemic heart disease and atrial fibrillation. c Respiratory diseases included pneumonia, clinical factors (with frequency ≥ 5%). The factors with acute bronchitis, acute exacerbation of underlying chronic respiratory conditions, pneumonitis, potential association (p ≤ 0.1) were further investigated respiratory failure and pneumothorax. d USD 1= HKD 7.8. doi: 10.2340/00015555-3118 Acta Derm Venereol 2019; 99: 616–617 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.