The humanistic, economic and societal burden of Herpes Zoster in Europe: a critical review

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.

Herpes Zoster in the Older Adult

“…25 Due to this lack of a consensus definition and the varying age ranges of the populations being studied, the incidence of PHN after HZ ranges from 5–30% and occurs in 50% of HZ affected individuals greater than 85 years. 2, 3, 5, 26–28 It is considered the most debilitating sequelae of HZ since it impairs the affected individual’s quality of life across all 4 health domains: physical, psychological, functional and social. 27 …”

Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial

“…HZ and PHN have major impacts on patients’ lives [29] and constitute a significant economic burden for health care systems and societies at large [30]. A treatment that effectively prevents PHN in patients at high risk could improve the quality of life of patients with HZ and also reduce health care costs.…”

Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

“…Up to 50% of patients with HZ and up to 81% of patients with PHN report a negative impact on their social and familiar relationships. 13,14 Several studies have shown that pain and other physical and psychological symptoms associated to HZ and PHN can significantly affect the productivity and working capacity of the affected population. 15 About 75% and 66% of subjects with HZ infection report a decrease of their concentration and work ability, and stopped working, respectively.…”