Supplementary Material
Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: a prospective study
Ruprecht Schmidt-Ott, Ulf Schutter, Jörg Simon, Barbara Poulsen Nautrup, Alfred von Krempelhuber, Kusuma Gopala, Anastassia Anastassopoulou, Adrienne Guignard, Desmond Curran, Sean Matthews, Emmanuelle Espié
Journal of Infection
Table SM1. Unit costs and their sources
Type of resource / Source and amountPhysician visits (generalist or specialist) / The total cost of a visit was taken from the Physicians’ fee schedule (EinheitlicherBewertungsmaßstab, EBM), codes 03000 and 03040. The amounts are as follows:
Age group / EBM 03000 / EBM 03040 / Total
19 - 53 years / €12.36 / €14.59 / €26.95
54 - 74 years / €15.90 / €14.59 / €30.49
≥75 years / €21.27 / €14.59 / €35.86
One visit per quarter is chargeable to the statutory health insurance (SHI), regardless of the number of actual visits.
For specialist visits, the basic lump sum was applied (EBM). The following assumptions were made, due to lack of more detailed information about the specialist visits:
- No additional procedure was performed;
- For radiologists, an angiography (by magnetic resonance imaging) was assumed to be performed, resulting in total cost of radiologist visit amounting to €111.74 for patients≤59 years and €112.65 for patients ≥60 years. Note, only one radiologist visit was recorded;
- The cost of drugs was identical whether prescribed by general practitioners or specialists.
Hospital visits / The mean cost per admission of patients aged 50 years or older with herpes zoster was taken from Ultsch et al. [1], adjusted by the ‘Consumer Price Index, inpatient medical services’.
- Amount: €3,493.68;
- Medications taken during hospital admissions are covered by the diagnosis-related group (DRG) lump sum;
- A patient co-payment of €10 per day for up to a maximum of 28 days is paid to the hospital and not to the SHI funds.
Medications / The unit costs of medications were taken from an official online database (LAUER-TAXE [2]) with information about all medications and vaccines available in Germany.
- Prescription medications (Rx) assumed to be covered by SHI;
- There is a patient co-payment of 10% of the price for Rx medications, amounting to minimum €5 and maximum €10;
- Pharmacies’ and manufacturers’ rebates were deducted;
- Over-the-counter drugs are paid in full by the patient.
Procedures / The unit costs of procedures were taken from the EBM.
- EBM code 34241 (X-ray thorax): €15.40;
- EBM code 33042 (echocardiography): €15.90;
- EBM code 32629 (lab test for varicella zoster virus antigen): €11.30.
Days of work lost / The productivity loss due to days of work lost was calculated as the number of days of work recorded as missed multiplied by the national average daily earnings obtained from the Eurostat website. The average loss of earnings per day was estimated as the annual salary divided by 252 days of work (365 - weekends - public holiday days). The amounts were:
- Females: 50 - 59 years: €137.03; ≥60 years: €126.11
- Males: 50 - 59 years: €202.37; ≥60 years: €171.14
- Caregiver: 153.50 €
1: Ultsch B, Siedler A, Rieck T, Reinhold T, Krause G, Wichmann O. Herpes zoster in Germany: Quantifying the burden of disease. BMC Infect Dis 2011; 11: 173; 2:Lauer Taxe, in: [accessed July 16, 2016].
Table SM2. Direct medical costs according to age group and analytical perspective (€)
Component / Perspective / 50 - 59 yrsN = 142 / 60 - 64 yrs
N = 59 / 65 - 69 yrs
N = 67 / 70 - 79 yrs
N = 182 / ≥80 yrs
N = 63 / Overall
N = 513
n / Mean
(€) / n / Mean
(€) / n / Mean
(€) / n / Mean
(€) / n / Mean
(€) / n / Mean
(€)
GP visits / HCS/Soc / 142 / 30 / 59 / 33 / 67 / 31 / 182 / 35 / 63 / 37.0 / 513 / 33
Medications / HCS / 129 / 50 / 53 / 66 / 62 / 60 / 167 / 64 / 59 / 64 / 470 / 60
Soc / 129 / 63 / 53 / 83 / 62 / 77 / 167 / 80 / 59 / 80 / 470 / 75
Procedures / HSC/Soc / 1 / 11 / 1 / 11 / 4 / 11 / 7 / 20 / 1 / 11 / 14 / 16
Spec. visits / HCS / 8 / 79 / 9 / 83 / 9 / 95 / 15 / 127 / 3 / 85 / 44 / 100
Soc / 8 / 96 / 9 / 102 / 9 / 11 / 15 / 148 / 3 / 99 / 44 / 120
Hospital
admission / HCS / 3 / 3,494 / - / - / - / - / 3 / 4,658 / 1 / 3,494 / 7 / 3,993
Soc / 3 / 3,591 / - / - / - / - / 3 / 4,788 / 1 / 3,591 / 7 / 4,104
Total / HCS / 142 / 154 / 59 / 105 / 67 / 100 / 182 / 182 / 63 / 157 / 513 / 152
Mean* / Soc / 142 / 168 / 59 / 123 / 67 / 119 / 182 / 201 / 63 / 174 / 513 / 169
N: Number of patients enrolled in this age group; n:Number of patients generating this cost component; Yrs:years old; mean: mean cost in€ averaging only over the patients generating this cost component; mean*: mean cost in € by averaging each cost component over all 513 patients and adding over all the cost component; GP: General practitioner; HCS: Healthcare system; Soc:Societal; Spec: Specialist
Table SM3. Indirect costs (productivity loss) by age group
Person concerned / Perspective / 50 - 59 yrsN = 142 / 60 - 64 yrs
N = 59
n / Mean (€) / n / Mean (€)
Caregiver / Societal / 2* / 1,228 / 1* / 1,382
Patient / HCS / 47 / 46.9 / 13 / 27.6
Societal / 47 / 1,158 / 13 / 1,141
Total / HCS / 47 / 46.9 / 13 / 27.6
Societal / 47 / 1,210 / 13 / 1,247
N: Number of patients enrolled in this age group; n: Number of patients concerned; yrs:years old; HCS: Healthcare system; *:only three caregivers who lost time from work were in paid employment
Figure SM1. Flow chart
Eligible HZ patients examined by physiciansN = 1,551
HZ patients enrolled in the study at the initial visit
N = 513
Patients providing pain assessment 90 days after rash onset
(ZBPI questionnaire)
N = 388
ZBPI ‘worst pain’ score ≥3 90 days after rash onset
N = 61
Patients providing pain assessment 180 days after rash onset
(ZBPI questionnaire)
N = 38
ZBPI ‘worst pain’ score ≥3 180 days after rash onset
N = 25
Patients providing pain assessment 270 days after rash onset
(ZBPI questionnaire)
N = 20
ZBPI ‘worst pain’ score ≥3 270 days after rash onset
N = 15
HZ: Herpes zoster; ZBPI: Zoster brief paininventory
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