The European Journal of Health Economics

, Volume 14, Issue 6, pp 1015–1026

Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany


    • Immunisation Unit, Department for Infectious Disease EpidemiologyRobert Koch Institute
    • CharitéUniversity Medical Centre
  • Ingrid Köster
    • PMV Research GroupUniversity of Cologne
  • Thomas Reinhold
    • Institute for Social Medicine, Epidemiology and Health Economics, CharitéUniversity Medical Centre
  • Anette Siedler
    • Immunisation Unit, Department for Infectious Disease EpidemiologyRobert Koch Institute
  • Gérard Krause
    • Department for Infectious Disease EpidemiologyRobert Koch Institute
    • Department for EpidemiologyHelmholtz Centre for Infection Research
  • Andrea Icks
    • Institute for Biometry and Epidemiology at the German Diabetes-CenterHeinrich Heine University
  • Ingrid Schubert
    • PMV Research GroupUniversity of Cologne
  • Ole Wichmann
    • Immunisation Unit, Department for Infectious Disease EpidemiologyRobert Koch Institute
Original Paper

DOI: 10.1007/s10198-012-0452-1

Cite this article as:
Ultsch, B., Köster, I., Reinhold, T. et al. Eur J Health Econ (2013) 14: 1015. doi:10.1007/s10198-012-0452-1


After acquiring a varicella virus infection, the virus can reactivate and cause herpes zoster (HZ)—a painful skin rash. A complication of HZ is long-term persistence of pain after the rash has resolved (so-called postherpetic neuralgia, PHN). We aimed to describe the epidemiology of HZ/PHN and to estimate HZ/PHN-related costs in the German statutory health insurance (SHI) system (~85 % of the total population). Treatment data of one large SHI was utilized, containing data on approximately 240,000 insured and their utilisation of services in 2004–2009. Identification of HZ- and PHN-cases was performed based on ‘International Statistical Classification of Diseases’ and specific medications using a control-group design. Incidences per 1,000 person-years (PY) and cost-of-illness for 1 year following HZ-onset considering the payer and societal perspective were calculated. All amounts were inflated to 2010 Euros. Population-figures were standardised and extrapolated to the total SHI-population in Germany in 2010. A mean annual incidence of 5.79 HZ-cases per 1,000 PY was observed, translating into an estimated 403,625 HZ-cases per year in the total SHI-population. Approximately 5 % of HZ-cases developed PHN. One HZ-case caused on average €210 and €376 of costs from the payer and societal perspective, respectively. The development of PHN generated additional costs of €1,123 (€1,645 societal perspective). Total annual HZ/PHN-related costs were estimated at €182 million (€105 million) to society (payer). HZ and PHN place a considerable burden on the German SHI-system. Since HZ-vaccines will soon be available, a health-economic evaluation of these vaccines should be conducted.


Herpes zosterPostherpetic neuralgiaEpidemiologyCost of illnessGermany

JEL Classification


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© Springer-Verlag Berlin Heidelberg 2012