What’s the Cost of Herpes Zoster?

The impact of herpes zoster (HZ) can be measured in a number of different ways.

For example patients measure it in terms of weeks of severe pain, itching, and resulting stress caused by the classic blistering shingles rash. Approximately 1 in 5 patients with HZ who develop postherpetic neuralgia (PHN) experience additional months or even years of life-changing pain. Other potentially serious complications include enteric zoster, Ramsay Hunt syndrome, and herpes zoster ophthalmicus.

However, it’s important to note that HZ also creates a number of substantial direct, indirect, and psychosocial costs. Direct costs include medical expenses, indirect costs cover productivity losses, and psychosocial costs refer to quality of life losses. A recently published review set out to develop comprehensive national estimates of the total burden of HZ among adults in the United States using those 3 criteria.¹

Researchers at the CDC and University of Michigan projected health and economic outcomes among adults aged 18 years and older using a 10-year time horizon. They undertook a comprehensive systematic literature review to generate outcomes, including cases of uncomplicated HZ, PHN, and ocular complications.¹

The study also noted that the national burden of direct, indirect, and psychosocial HZ costs is substantial. “Using simulation modeling, an unvaccinated US population would be projected to experience 1.1 million herpes zoster cases annually, with an associated direct medical cost of $2.4 billion,” the authors wrote. The authors also projected the annual number of PHN cases and ocular complications to be 114,000 and 43,000 respectively, resulting in the loss of approximately 67,000 quality-adjusted life years.¹

“HZ, a vaccine-preventable illness, serves as a particularly useful model since these results can inform economic analyses for HZ vaccination,” they concluded.¹

Vaccination against HZ is the only available option for reducing the number of shingles cases, related complications and, by extension, associated direct, indirect, and psychosocial costs. Without vaccination, the CDC estimates that approximately 1 out of every 3 individuals in the United States will develop shingles in their lifetime.² Although the risk of shingles increases in the population over the age of 40, even children and young adults can be at risk.

Of the 2 shingles vaccines licensed in the United States to prevent shingles - Shingrix and Zostavax - Shingrix is the preferred choice of the Advisory Committee on Immunization Practices and is recommended for healthy adults aged 50 and older. Zostavax is recommended for healthy adults aged 60 years and older who are allergic to Shingrix, prefer Zostavax, or who specifically request it and Shingrix is not available.

References:

• Harvey M, Prosser LA, Rose AM, et al. Aggregate health and economic burden of herpes zoster in the United States: illustrative example of a pain condition. Pain. 2019. 10.1097/j.pain.0000000000001718

• CDC. Shingles (Herpes Zoster). CDC’s website. https://www.cdc.gov/shingles/index.html.