Economic Burden of Herpes Zoster Ophthalmicus in New Zealand: A Retrospective Cohort Cost Analysis

Purpose: The aim of this study was to estimate the direct health care cost burden of herpes zoster ophthalmicus (HZO) in New Zealand and to evaluate potential implications for shingles vaccination policy. Methods: This retrospective cohort study analyzed 869 participants with HZO treated at Greenlane Eye Clinic, Auckland, using data from the Auckland Zoster Study. Clinical and demographic data were reviewed and cross-referenced with hospital electronic databases. The total number of hospital visits, medications, and procedures associated with HZO and its complications were recorded. Unit costs were derived from New Zealand pricing data, and cumulative hospital-based direct health care costs were calculated. Factors associated with health care costs were evaluated using a generalized linear model (GLM) with a gamma distribution and log link, with multivariable linear regression performed as a sensitivity analysis. Results: The median follow-up was 6.3 years [IQR 3.7–8.9]. The average hospital-based health care cost captured in this study was New Zealand dollars $3185.95 ± 6791.22 (range $30.49–$85,967.59). Mean inpatient, outpatient, drug, and procedure costs were $278.82 ± 1628.79, $2231.16 ± 3762.62, $113.51 ± 1288.57, and $562.45 ± 2582.89, respectively. In multivariable GLM analysis, higher health care costs were independently associated with older age ( P < 0.001), immunosuppression ( P = 0.047), uveitis ( P < 0.001), optic neuropathy ( P < 0.001), and recurrent disease ( P < 0.001). Conclusions: HZO imposes a significant direct health care cost burden on the New Zealand health care system. These findings provide important local cost data for future economic evaluations, including cost-effectiveness analyses of HZ prevention strategies.