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


Authors: Dommasch, E. D.; Joyce, C. J.; Mostaghimi, A
Article Title: Trends in Nationwide Herpes Zoster Emergency Department Utilization From 2006 to 2013
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: 18 to 19 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 1350957 ED visits for HZ were identified between 2006 and 2013, representing 0.13% of all US ED visits. Of these patients, 563200 (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 18 to 19 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 (18-19 and gt;/=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.
Keywords: Public Health Sciences; Public Health
Journal Title: JAMA dermatology
ISSN: 2168-6084; 2168-6068
Publisher: Unknown  
Journal Place: United States
Date Published: 2017
Language: eng
DOI/URL:
Notes: LR: 20170621; JID: 101589530; aheadofprint