Relative increase in healthcare resource usage in herpes zoster cases compared to controls in acute/sub-acute phase and equivalent time periods before and after.

<p>Note: CI, confidence interval, ED, emergency department, GP, general practitioner.</p

Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults

<div><p>Background</p><p>Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age.</p><p>Methods</p><p>In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population.</p><p>Results</p><p>Per HZ case, there was an average of 0.06 (95% CI 0.04–0.08) excess hospitalisations, 1.61 (95% CI 1.51–1.69) excess general practitioner visits, 1.96 (95% CI 1.86–2.15) excess prescriptions filled and 0.11 (95% CI 0.09–0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719–2767); GP visits was highest in those 60–69 years (N = 50567, 95%CI 39958–61105), prescriptions and ED visits were highest in 70–79 years (N = 50524, 95%CI 40634–60471 and N = 2891, 95%CI 2319–3449 respectively).</p><p>Conclusions</p><p>This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted.</p></div

Estimated excess healthcare usage (excess hospitalisations, general practitioner visits, prescriptions, and emergency department visits) due to herpes zoster in period 21 days prior and until 90 days after onset.

<p>Estimated excess healthcare usage (excess hospitalisations, general practitioner visits, prescriptions, and emergency department visits) due to herpes zoster in period 21 days prior and until 90 days after onset.</p

Characteristics of cases with herpes zoster and matched controls.

<p>Characteristics of cases with herpes zoster and matched controls.</p

Healthcare resource usage in herpes zoster cases and controls per 1000 population in relation to time at diagnosis or index day (day = 0).

<p>Note: ED, emergency department, GP, general practitioner.</p

Median number of dog bites reported during 2004–2013 to the Department of Health Services, Ministry of Health and Population.

<p>See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004461#pntd.0004461.s004" target="_blank">S4 File</a> for raw data and abbreviations.</p

Number of rabies outbreaks reported during 2005–2014 to the Veterinary Epidemiology Center of the Directorate of Animal Health, Department of Livestock Services, Ministry of Agricultural Development.

<p>See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004461#pntd.0004461.s004" target="_blank">S4 File</a> for raw data and abbreviations.</p

Estimated mean number of rabies deaths in Global Burden of Disease studies.

<p>WHO: World Health Organization Global Health Estimates [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004461#pntd.0004461.ref051" target="_blank">51</a>]; GBD2010: Global Burden of Disease 2010 Study [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004461#pntd.0004461.ref052" target="_blank">52</a>]; GBD2013: Global Burden of Disease 2013 Study [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0004461#pntd.0004461.ref053" target="_blank">53</a>].</p

Animal rabies cases and number of vaccinated animals during 2005–2014, as reported to the Veterinary Epidemiology Center of the Directorate of Animal Health, Department of Livestock Services, Ministry of Agricultural Development.

<p>Animal rabies cases and number of vaccinated animals during 2005–2014, as reported to the Veterinary Epidemiology Center of the Directorate of Animal Health, Department of Livestock Services, Ministry of Agricultural Development.</p

Flow diagram of systematic review.

<p>Flow diagram of systematic review.</p