Herpes Zoster Incidence and Burden in Adults with Type 2 Diabetes Mellitus in the United States: A Retrospective Database Analysis

Objective Data on real-world burden of herpes zoster (HZ) in adults with type 2 diabetes mellitus (T2D) in the U.S. are limited. We assessed HZ in patients with and without T2D and measured the impact of HZ on healthcare resource use (HCRU) and costs.

Research design and methods A retrospective cohort analysis using U.S. commercial claims data (sourced from claims incurred between January 1, 2012 and July 31, 2018). HZ incidence rates/1,000 person-years [PY] were calculated in patients with/without T2D; HZ risk was evaluated using Poisson regression to generate adjusted incidence rate ratios (aIRRs).  T2D patients with HZ were propensity score matched to patients with T2D only, and to patients with HZ without T2D. HCRU and costs were compared across cohorts during a 1-year follow-up period. Cox proportional hazards analyses evaluated factors associated with HZ-related complications. 

Results Crude HZ incidence rates in patients with and without T2D were 9.8/1,000 PY and 2.6/1,000 PY respectively. T2D patients were almost twice as likely to be diagnosed with HZ (aIRR, 1.84 [95% CI: 1.82–1.85]). HZ was associated with increased HCRU and healthcare costs. At 12-months, unadjusted incremental all-cause healthcare costs for T2D patients with HZ versus T2D patients without HZ were $5,216; unadjusted incremental HZ-related healthcare costs for T2D patients with HZ versus patients with HZ without T2D were $2,726. Age was the most important predictor for HZ-related complications.

Conclusions Given the increased risk of HZ and HCRU and cost burden in T2D patients, HZ prevention in T2D patients may be beneficial.