What are trends in emergency department utilization, costs for shingles?

A new article published by JAMA Dermatology uses a nationwide database of emergency department (ED) visits to examine herpes zoster (HZ, shingles)-related ED utilization and costs.

HZ can develop in anyone who has had varicella (chicken pox) or gotten the varicella vaccine, although the risk is lower in those who were vaccinated. The chicken pox vaccine was introduced into the U.S. vaccination schedule in 1995 for children 12 months or older. A vaccine for HZ has been available in the United States since 2006 and it can reduce the likelihood of developing HZ in adults 60 and older, for whom vaccination is recommended.

Arash Mostaghimi, M.D., M.P.A., M.P.H., of Harvard Medical School and Brigham and Women's Hospital, Boston, and coauthors identified more than 1.3 million HZ-related ED visits from 2006 through 2013, representing 0.13 percent of all ED visits in the United States.

Between 2006 and 2013, the percentage of HZ-related ED visits increased from 0.13 percent to 0.14 percent (8.3 percent) and that growth was driven by patients 20 to 59 years old. HZ-related ED visits decreased for patients ages 18 to 19 and for patients 60 and older. For all age groups, overall average charges for HZ-related ED visits increased from $763 to $1,262, according to the results.

"Our study found an increase in total ED visits associated with HZ between 2006 and 2013 due to an increased number of visits by patients aged 20 to 59 years. Despite decreased utilization in paitents aged less than 20 years and 60 years or older, we found increased total adjusted charges in these populations. Our findings suggest that vaccination may be associated with a reduction of ED utilization. Further research is necessary to identify the drivers of increased costs," the study concludes.

Researchers caution their study doesn't allow them to directly link the change in utilization to vaccination.