Abstract
BackgroundHerpes zoster (HZ) or “shingles” is common in persons aged 50 years or over. HZ is characterised by a painful dermatological rash which typically resolves in approximately one month. Persistent pain for months or years after rash onset, however, is a common complication of HZ; referred to as post-herpetic neuralgia (PHN). Both HZ and PHN have a significant impact on patients’ lives, with considerable implications for healthcare systems and wider society. The aim of the present review is to provide comprehensive documentation and critical appraisal of published data concerning the humanistic, economic and societal burden of HZ in Europe.MethodsSystematic literature searches were conducted in Medline, EMBASE, PsycINFO, EconLit, HEED and CRD databases. Searches were conducted in July 2014 and restricted to articles published in the past 20 years. Articles were selected for full review by two independent researchers in accordance with predefined eligibility criteria.ResultsFrom a review of 1619 abstracts, 53 eligible articles, were identified which reported data concerning healthcare resource use (n = 38), direct costs (n = 20), indirect costs (n = 16), total costs (n = 10) and impact on health-related quality of life (HRQoL) (n = 21). Findings highlight that PHN is associated with greater impairments in HRQoL and higher costs of management than HZ. For both HZ and PHN, pain severity is a significant predictor of impact on individuals, healthcare systems and society. While the incidence of HZ and PHN increase with age, age does not appear to be a key driver of overall costs for HZ and PHN. Specifically, while direct costs (e.g. GP, specialists, medications, hospitalisations) tend to be higher for older patients, indirect costs (e.g. work time missed) are higher for younger patients.ConclusionsAvailable evidence highlights that HZ and PHN result in significant humanistic and economic burden for patients, healthcare systems and wider societies. A tendency to focus upon healthcare resource use and the direct costs of management at the expense of other impacts (e.g. informal caregivers and formal social care) may result in an underestimation of the true burden of HZ and PHN.
Highlights
Herpes zoster (HZ) or “shingles” is common in persons aged 50 years or over
A tendency to focus upon healthcare resource use and the direct costs of management at the expense of other impacts may result in an underestimation of the true burden of HZ and post-herpetic neuralgia (PHN)
39 reported data attributed to HZ patients and 35 reported data attributed to PHN patients
Summary
Herpes zoster (HZ) or “shingles” is common in persons aged 50 years or over. Persistent pain for months or years after rash onset, is a common complication of HZ; referred to as post-herpetic neuralgia (PHN). Both HZ and PHN have a significant impact on patients’ lives, with considerable implications for healthcare systems and wider society. The great majority (95%) [2] of the population hosts VZV and approximately one in four persons will develop HZ in their lifetime through reactivation, leading to an estimated 1.7 million episodes in Europe annually [3]. Herpes Zoster Ophthalmicus (HZO) occurs in 10-20% of all HZ cases and in some cases can lead to ocular complications [5]
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