Epidemiology and cost of herpes zoster and postherpetic neuralgia among patients treated in primary care centres in the valencian community of Spain

Abstract

BackgroundData on the epidemiology and costs related to herpes zoster (HZ) and postherpetic neuralgia (PHN) in Spain are scarce; therefore, studies are needed to evaluate the epidemiological and economic impact of HZ and its most common complication, PHN. The present study aimed to estimate the clinical and economic burden of HZ and PHN in Valencia (Spain).MethodsWe prospectively analyzed the burden of HZ and PHN and their attributable costs in patients from 25 general practices in the Autonomous Community of Valencia serving 36,030 persons aged > 14 years. All patients with a clinical diagnosis of HZ who attended these centers between December 1st 2006 and November 30th 2007 were asked to participate. Patients included were followed for 1 year.ResultsOf the 130 cases of HZ followed up, continued pain was experienced by 47.6% (95% confidence interval (CI) = 35.6-56.7%) at 1 month after rash onset, by 14.5% (95% CI = 7.8-1.2%) at 3 months, by 9.0% (95% CI = 3.7-14.3%) at 6 months, and by 5.9% (95% CI = 1.5-10.3%) at 12 months. The percentage of patients with PHN increased with age, from 21.4% (95% CI = 8.3-40) in patients < 50 years to 59.2% (95% CI = 44.4-74) in patients ≥ 70 years. The estimated total cost for the 130 HZ cases during the follow-up period was €49,160 ($67,349). Mean cost per patient was €378 (range 53-2,830) ($517, range 73-3,877).ConclusionsThis study shows that PHN is a relatively common complication of HZ and that both conditions combined give rise to a significant clinical and economic burden for patients and providers.

Herpes zoster and postherpetic neuralgia in Catalonia (Spain)

“…A recent study has shown no significant differences in the incidence of HZ between European countries. 24 In addition, studies in Spain (Navarre, 19 Valencia, [14][15][16] and Madrid 18 ) based on administrative data from primary healthcare show very similar results (overall incidence in all age groups of about 4 per 1000 inhabitants, although the Valencian study 14,15 did not include subjects aged <14 y). The study by Yawn et al, 7 one of the most comprehensive epidemiological studies of HZ, found similar incidence rates to those observed in Spain, as did other studies performed in Europe, [25][26][27][28][29] Israel, 30 and the United States.…”

“…In Spain, incidence studies of HZ have been published based on data obtained from public primary healthcare centers in Valencia, [14][15][16] Madrid 17,18 and Navarre. 19 In Navarre, which has an excellent public health system, the proportion of patients seen by private family physicians and dermatologists is very low.…”

“…[14][15][16][17][18][19] However, information on the epidemiology of PHN (proportion of cases of HZ that evolve to PHN, the incidence of PHN in the general population, the clinical and epidemiological characteristics of PHN, etc.) and, especially, the characteristics of pain in the different stages of HZ, is limited.…”

Is There any Seasonal Influence of Herpes Zoster?

“…Zoster may occur less frequently in tropical areas, because of later acquisition of primary infection 25 . Most of the study neither found any seasonal variation 9,16,17 nor any epidemic 9 .…”

“…It is prevalent worldwide, occurs more sporadically than does primary infection (varicella) 6 . Age is one of the strong risk factor for HZ [9][10][11][12][13] . It is uncommon in childhood and the incidence increases with age 5,10,17 .…”