Price of pain: population-based cohort burden of disease analysis of medication cost of herpes zoster and postherpetic neuralgia

Abstract

Background: Pain is a main symptom of herpes zoster (HZ), and postherpetic neuralgia (PHN) is a frequent complication occurring in 5% to 15% of cases, causing moderate to severe neuropathic pain. A population-based observational study was conducted to evaluate the treatment patterns and economic burden of prescription drug treatment of HZ and PHN pain in the province of Manitoba (Canada) over a period of 15 years.

Methods: Administrative health care data, including medical and hospital separation records, were examined to identify episodes of HZ using International Classification of Diseases-9/10 codes between April 1, 1997 and March 31, 2014. Episodes of PHN were identified using medical and prescription claims. Incident use of analgesic, antidepressant, or anticonvulsant drugs was used to determine prescription pain costs.

Results: The age-adjusted incidence of HZ increased from 4.7 episodes/1,000 person-years in 1997/98 to 5.7/1,000 person-years in 2013/14. PHN occurred in 9.2% of HZ cases, a rate that did not change over the study period (P=0.57). The annual cost to treat HZ pain rose by 174% from 1997/98, reaching CAD $332,981 in 2011/12, 82.8% (95% confidence interval [CI] 81.2%, 84.3%) of which was related to PHN. The per episode cost of HZ rose by 111% from $31.59 (95% CI $25.35, $37.84) to $66.81 (95% CI $56.84, $76.78) and by 94% for PHN from $292 (95% CI $225, $358) to $566 (95% CI $478, $655). These increases were driven by increasing use of anticonvulsants, primarily gabapentin, which accounted for 57% of the increase in cost.

Conclusion: There has been an increase in the incidence of HZ and PHN and in the average cost associated with the prescription treatment of their resultant neuropathic pain. The primary driver of the increased episodic cost is the increased use of gabapentin. These changes have resulted in a substantial increase in the economic burden associated with HZ and PHN.

Keywords: cost; economics; gabapentin; neuropathic pain; shingles.

Figure 1

Mean cost per episode of herpes zoster-associated pain treatment by age at diagnosis. Costs adjusted for inflation to 2013 Canadian dollars.

Figure 2

Treatment of postherpetic neuralgia episodes by drug class. Notes: Numbers of episodes treated by drug class. A single episode can be treated with more than one class of drug, thus a single episode can contribute data to more than one category. Abbreviation: NSAID, nonsteroidal anti-inflammatory drug.

Figure 3

Distribution of days of drug treatment per episode by class. Notes: Boxplot of the number of days of drug treatment per episode by drug class for herpes zoster with postherpetic neuralgia. ◊ = mean. Abbreviation: NSAID, nonsteroidal anti-inflammatory drug.