[Skip to Content]
[Skip to Content Landing]
Original Investigation
September 2017

Trends in Nationwide Herpes Zoster Emergency Department Utilization From 2006 to 2013

Author Affiliations
  • 1Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
  • 3Department of Public Health Sciences, Loyola University, Chicago, Illinois
  • 4Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Dermatol. 2017;153(9):874-881. doi:10.1001/jamadermatol.2017.1546
Key Points

Question  What is the effect of vaccination on emergency department utilization for herpes zoster?

Findings  In this population-based, descriptive epidemiologic study of more than 1.3 million herpes zoster–related emergency department visits from 2006 through 2013, the overall rate of visits rose by 8.3%, driven by an increased number of visits by patients aged 20 to 59 years; populations recommended for vaccination (aged <20 and ≥60 years) demonstrated a decrease in utilization. Herpes zoster annual incidence rates fell after the recommended use of the herpes zoster vaccine in 2008 in patients 60 years or older.

Meaning  Vaccination may be associated with a reduction of emergency department utilization for herpes zoster.

Abstract

Importance  The effect of vaccination on emergency department (ED) utilization for herpes zoster (HZ) has not been examined to date.

Objective  To determine trends in US ED utilization and costs associated with HZ.

Design, Setting, and Participants  The Nationwide Emergency Department Sample data set was examined for temporal trends in the number of visits and costs for treatment of HZ in EDs in the United States from January 1, 2006, through December 31, 2013. Cases of HZ were identified using validated International Classification of Diseases, Ninth Revision–Clinical Modification diagnosis codes. Patients were stratified by age: less than 20 years (varicella vaccine recommended), 20 to 59 years (no vaccine recommended), and 60 years or older (HZ vaccine recommended). Population-based rates were estimated using sampling weights.

Main Outcomes and Measures  Population-based incidence rates of HZ-related ED visits, charge for ED services, and total charges.

Results  A total of 1 350 957 ED visits for HZ were identified between 2006 and 2013, representing 0.13% of all US ED visits. Of these patients, 563 200 (51.7%) were male; mean (SE) age was 54.0 (0.1) years. Between 2006 and 2013, the percentage of HZ-related ED visits increased from 0.13% to 0.14% (8.3%). This growth was driven by patients aged 20 to 59 years (increase of 22.8% [from 0.12% to 0.14% of ED visits]) while the proportion of ED HZ visits decreased for patients aged less than 20 years and 60 years or older, from 0.03% to 0.02% (−39.6%) and from 0.28% to 0.25% (−10.9%), respectively. For all age groups, there was an increase from 2006 to 2013 in overall adjusted total (from $92.83 to $202.47 million) and mean charges (from $763 to $1262) for HZ-related ED visits.

Conclusions and Relevance  The number of ED visits and total cost associated with HZ increased between 2006 and 2013. Greater use was driven by an increased number of visits by patients aged 20 to 59 years, but populations recommended for vaccination (<20 and ≥60 years) demonstrated decreased ED utilization. Per-visit and total costs increased across all age groups. Vaccination may be associated with a reduction of ED utilization. Further research is required to confirm these results and examine the drivers of increased ED costs.

×