Herpes zoster incidence and cost in patients receiving autologous hematopoietic stem-cell transplant

Abstract

Objective: Among patients receiving autologous hematopoietic stem cell transplant (Auto-HSCT), this study estimated the incidence of herpes zoster (HZ), compared healthcare costs among patients with and without HZ, and evaluated antiviral prophylaxis (AP) use.

Research design and methods: A retrospective study was conducted using data from a large health plan to identify patients ≥18 years with ≥1 claim for an Auto-HSCT procedure during 2006–2011 (n = 2,530). Patients were followed from date of Auto-HSCT until risk-end date, defined as development of HZ, end of enrollment, death, or December 31, 2011. HZ incidence was calculated as cases observed after Auto-HSCT, divided by accrued time-at-risk in person-years (PY). AP use and duration were defined by prescription fills. One-year medical and pharmacy costs were calculated as combined health plan and patient paid amounts.

Main outcome measures: HZ incidence and healthcare costs were calculated using administrative claims data.

Results: Overall HZ incidence was 62.2/1,000 PY (95% CI = 54.3–70.9). Most (72.3%) patients were prescribed AP. During the first 90-days post-Auto-HSCT, patients without AP had increased incidence (151.6/1,000 PY, 95% CI = 88.3–242.6) compared to those prescribed AP pre- (30.9/1,000 PY, 95% CI = 11.3–67.2) or post-Auto-HSCT (33.0/1,000 PY, 95% CI = 13.3–67.9). Total adjusted mean 1-year all-cause healthcare costs were $74,875 for patients who developed HZ and $70,279 for patients who did not (difference = $4,596 (cost ratio = 1.07, 95% CI = 0.86–1.32, p = .566)).

Conclusions: HZ incidence was high, despite AP use. Mean annual healthcare costs were higher for patients with HZ, but the difference was not statistically significant. An effective vaccine against HZ could be useful in decreasing both incidence of and cost for HZ in this population.

Keywords:

• Autologous HSCT
• herpes zoster
• varicella zoster virus
• antiviral prophylaxis

Transparency

Declaration of funding

This study was funded by Merck & Co., Inc., Kenilworth, NJ, USA.

Declaration of financial/other relationships

Jianbin Mao and Jeffrey McPheeters are employed by Optum, and have no potential conflicts of interest to disclose. Dongmu Zhang, Camilo J. Acosta, and Lynn Finelli are employed by Merck & Co. and have no potential conflicts of interest to report.

Acknowledgments

The authors wish to acknowledge the assistance of Jen Wogen, MedMentis Consulting LLC, for medical writing assistance in support of this manuscript. The authors also wish to thank Lynn Wacha at Optum for programming all study variables, and Laura Becker and Djibril Liassou (both at Optum) for their assistance with creating data tables and statistical analysis.

Previous presentation

Portions of this study were presented at ID Week, New Orleans, LA, October 26–30, 2016.