Resource Consumption and Health Care Costs of Herpes Zoster and Postherpetic Neuralgia in Germany

Aim: Herpes zoster (HZ, shingles) often occurs after the 50th year of age, and characteristic skin lesions, pain and dysesthesias are the predominant symptoms. While the associated acute and chronic pain does not only have a considerable impact on the health related quality of life of the persons, the primary therapy of HZ as well as the analgesic therapy also cause costs for the health care system and the society. The aim of the present analysis was to assess the consumption of resources and the costs of HZ and its complication postherpetic neuralgia (PHN) on the basis of routine health care data of a German statutory health insurance. Method: Immune-competent patients above the age of 50 years with a first diagnosis of HZ or PHN in 2004 were identified by the ICD-10 encoded diagnosis from the data of the Statutory Health Insurance (SHI) sample AOK Hesse/KV Hesse. After the identification of cost-relevant categories like physician contacts, diagnostic investigations, prescribed medications, hospital care, benefits in kind and sick leave, the patient-related costswere specified from SHI perspective (direct costs) and societal perspective (direct and indirect costs). Costs due to hospital care and sick leave could be directly attributed to the diagnosis, costs due to physician contacts, diagnostic tests and benefits in kind were estimated as excess costs per patient in the year after the HZ diagnosis compared to the year before HZ diagnosis. Results: The average excess costs per HZ-case in 2004 were 593.15 (sic), per PHN-case 1762.51 (sic). Thus, PHN led to significantly higher costs. The direct costs of HZ and PHN increased with age. Indirect costs due to sick leave were highest in the group of 50 - 59 year old patients and account for the highest proportion of total costs in this age group. Conclusion: Due to demographic ageing, i.e. the proportion of older people within the German population, a rise in costs as a result of HZ and PHN for the health care system and the society is expected. In addition, indirect costs due to sick leave caused by HZ/PHN will presumably increase rather than decrease.