The Prognosis with Postherpetic Neuralgia

Watson, C. Peter N.; Watt, Verna R.; Chipman, Mary L.; Birkett, Nicholas; Evans, R. J.

doi:10.1097/00132586-199236030-00042

Cited by 11 publications

(15 citation statements)

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“…Although it is expected that the majority of medical RU and costs are included in the first year, the literature suggests that the pain of PHN can persist beyond 1 year. [25,26] Other complications could also result in RU and medical expenditures beyond 1 year, such as surgery to remove scar tissue.…”

Section: Discussionmentioning

confidence: 99%

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Incremental 1-Year Medical Resource Utilization and Costs for Patients with Herpes Zoster from a Set of US Health Plans

et al. 2009

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The medical RU and cost data were obtained from the MarketScan Research Database for the years 1998-2003. This database contains inpatient, outpatient and prescription drug data for approximately 14 million individuals of all ages, covered under a variety of fee-for-service and capitated provider reimbursement arrangements, including those with Medicare and private insurance. The work loss estimates were based on the MarketScan Health and Productivity Management Database. Claims for services incurred between 1 January 1998 and 31 December 2003 were screened to identify a cohort of HZ patients based on the presence of at least one International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 053.xx. Each patient was assigned an index date based on the earliest observed occurrence of an HZ diagnosis. A cohort of PHN patients was identified as a subset of the HZ cohort with ICD-9 codes 053.12, 053.13, 053.19 or 729.2x in the period of 90 days to 12 months after the index date. Multivariable regression was used to compare HZ cases with matched controls after adjusting for demographic characteristics, insurance status, co-morbidities and medical expenditure in the 6 months prior to diagnosis for each of the endpoints. Separate regression models were developed, in which age and immune status were stratified. All costs were adjusted to March 2008 values using the medical care component of the Consumer Price Index. The average per patient cost of all HZ cases was $US605 in the first 90 days after diagnosis and $US1052 at 1 year. For the subset with PHN, the average per patient cost of HZ at 1 year was $US3815. For the subset with an immunocompromising condition, the average HZ cost at 1 year was $US1745. The majority of the costs were the result of outpatient visits and prescription drugs. The subset of HZ cases that had both absence hour and short-term disability (STD) records available had 26.5 absence hours and 2.9 STD days. Healthcare utilization, medical care costs and work loss all increased with age for all HZ cases. Based on the results from the present study, the direct medical cost burden of HZ in the US is high, exceeding $US1000 per HZ patient. This direct medical cost may be nearly twice as high in immunocompromised patients and four times as high in the subset of HZ cases with PHN. The direct medical cost burden of HZ may exceed $US1 billion annually in the US. The majority of medical RU and cost burden is incurred by the elderly. Although many people with HZ may no longer be in the workforce, HZ does contribute to lost work time.

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Section: Discussionmentioning

confidence: 99%

“…[8,[14][15][16][17][18][19][20][21][22][23][24] This pain can persist for more than a year after rash onset. [25,26] In the present study, the acute/sub-acute phase is defined as the first 3 months after rash onset, and the chronic phase or PHN as pain persisting >3 months after rash onset.…”

Section: Introductionmentioning

confidence: 99%

Incremental 1-Year Medical Resource Utilization and Costs for Patients with Herpes Zoster from a Set of US Health Plans

et al. 2009

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“…One is that the excitability of ganglionic or spinal cord neurons is altered during recovery 64 . The second is that persistent productive VZV infection exists in ganglia, a notion that is supported by possible chronic ganglionic inflammation in PHN 65 . A third theory is that PHN might be due to gene expression and protein production without virus replication but with disturbance of neuronal physiology.…”

Section: Neurological Complications Of Zostermentioning

confidence: 99%

Varicella-Zoster Virus Infection

Gilden¹,

LaGuardia²

2003

Clinical Neurovirology

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A.A.G. declares service contracts from Merck to investigate the safety of VZV vaccines (identifying VZV in samples from patients with possible adverse reactions), chairs an independent data monitoring committee for GlaxoSmithKline's Phase III subunit glycoprotein E zoster vaccine trial, consults with Pfizer when invited, and has participated in an educational programme (supported by an unrestricted educational grant) on zoster for GlaxoSmithKline. P.G.E.K. has served on a scientific advisory board on zoster vaccination for Sanofi Pasteur MSD. Y.K. is Director General of the BIKEN foundation (The Research Foundation for Microbial Diseases of Osaka University), which produces varicella vaccines.

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“…In some cases, patients do well. In a study of 88 patients with protracted (≥ 1 year) pain assessed in a pain clinic, one third had mild pain and no disability when reassessed an average of 2 years later [7]. Helgason et al [4] followed 13 patients with PHN of 12 months' duration for an average of 6 years; seven of them became pain-free between 2 and 7 years.…”

Section: Natural Course Of the Diseasementioning

confidence: 99%

Treatment of postherpetic neuralgia

Nurmikko

Haanpää²

2005

Current Science Inc

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Postherpetic neuralgia (PHN) remains one of the most troublesome common chronic neuropathic pain conditions. Many controlled trials have been published showing good efficacy and reasonable tolerability. These include gabapentinoids, opioids, tricyclic antidepressants, and topical lidocaine and capsaicin. Combination therapies are possible, but have not been proven, and long-term follow-up is limited. Only few case series exist for surgical and other invasive therapies and their role remains uncertain.

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The Prognosis with Postherpetic Neuralgia

Cited by 11 publications

References 0 publications

Incremental 1-Year Medical Resource Utilization and Costs for Patients with Herpes Zoster from a Set of US Health Plans

Incremental 1-Year Medical Resource Utilization and Costs for Patients with Herpes Zoster from a Set of US Health Plans

Varicella-Zoster Virus Infection

Treatment of postherpetic neuralgia

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