OBJECTIVES: Herpes zoster (HZ) and its related complications incur a significant healthcare burden in Europe. We assess the impact of HZ and postherpetic neuralgia (PHN) on healthcare resources in Region Västra Götaland (VGR), Sweden.

METHODS: A retrospective cohort study of all adults ≥18 years old (YO) diagnosed with primary or secondary HZ from 2012-2020 was conducted using the VGR healthcare registers VEGA and Digitalis. Healthcare resource use included primary care, inpatient care, specialist outpatient care and antiviral drugs. The associated costs were computed based on registered cost per patient and on the region’s standardized costs and adjusted to 2022 price levels using Sweden’s consumer price index.

RESULTS: In 2019, 13,273 healthcare visits were reported with HZ as a primary or secondary diagnosis, including 12,076 primary care visits (2.1 visits/episode) and 1,127 specialist outpatient visits (0.2 visits/episode). There were 70 hospitalizations with HZ as the primary diagnosis, corresponding to 0.012 hospitalization/episode and ~5.8 days/hospitalization. Approximately 28.5% of hospitalizations were emergency ward visits. Most visits (11,221; 93%) were among patients ≥50 YO, including 10,243 primary care visits, 913 specialist outpatient visits, and 65 hospitalizations.

Healthcare utilization was more pronounced among PHN patients in primary care, with 7.1 visits/HZ episode compared to 1.7 visits/non-PHN HZ episode.

In 2019, annual healthcare costs with HZ as a primary diagnosis for all HZ patients were ~€2.6 million versus ~€2.2 million for those ≥50 YO. These included primary care (€1.7 million versus €1.5 million), inpatient care (€0.4 million, respectively), specialist outpatient care (€0.4 million versus €0.3 million) and antiviral costs (€0.08 million versus €0.07 million). The total cost per HZ episode was €443 (≥50YOA = €484), which increased to €1,503 for HZ patients with PHN (excluding long-lasting pain management costs).

CONCLUSIONS: The current study demonstrates a substantial burden of HZ in which may be eased by introducing adult HZ vaccination.