Aggregate health and economic burden of herpes zoster in the United States: illustrative example of a pain condition.

Our objective was to develop comprehensive national estimates of the total burden of herpes zoster (HZ) among U.S. adults, including direct (ie, medical costs) and indirect (ie, productivity losses) costs, as well as its psychosocial impact (ie, quality of life losses). Using a patient-level microsimulation model, we projected health and economic outcomes among U.S. adults aged 18 years and older using a 10-year time horizon. We conducted a comprehensive systematic literature review to generate parameter values and conducted simulation modeling to generate our outcomes, including numbers of cases of uncomplicated HZ, postherpetic neuralgia (PHN), and ocular complications, productivity losses, and losses in quality-adjusted life years (QALYs). We used a societal perspective for outcomes; the costing year was 2015. Projected outcomes for an unvaccinated population included 1.1 million HZ cases, 114,000 PHN cases, and 43,000 ocular complications annually, resulting in approximately 67,000 QALYs lost. HZ and its complications would incur costs of $2.4 billion in direct medical costs and productivity losses annually. Projected QALY losses were most sensitive to HZ and PHN health utility values in the model. Cost estimates were most sensitive to the probability of HZ and to the costs per episode of PHN. The national burden of direct, indirect, and psychosocial HZ costs is substantial. Our results can inform economic analyses for HZ vaccines. Comprehensive, national assessments of the total burden of other painful conditions would be very informative.

Treatment of herpes zoster ophthalmicus: a systematic review and Canadian cost-comparison.

OBJECTIVE: A systematic review and cost comparison were conducted to determine the optimal treatment of active herpes zoster ophthalmicus (HZO) in immunocompetent adults. DESIGN: A literature search of MEDLINE, EMBASE, CINAHL, Cochrane Library, BIOSIS Previews and Web of Science, ClinicalTrials.gov, International Clinical Trials Registry Platform, Networked Digital Library of Theses and Dissertations, and Canadian Health Research Collection was performed. The search period was from January 1990 to March 2017. PARTICIPANTS: Collectively, 516 immunocompetent patients with active HZO treated with oral antivirals were included. METHODS: Randomized controlled trials (RCTs) investigating treatment of active HZO in immunocompetent adults, with one oral acyclovir monotherapy arm, were included. Studies fulfilling inclusion criteria were subjected to quality assessment and data extraction. Provincial drug formularies were consulted to extrapolate cost comparison for investigated treatment regimens. RESULTS: A total of 1515 titles and abstracts and 9 full-text articles were assessed. Three RCTs met the inclusion criteria. Treatment with oral acyclovir (800 mg 5 times daily for 10 days) was superior to placebo in the prevention of ocular manifestations. Oral famciclovir (500 mg 3 times daily for 7 days) and valacyclovir (1000 mg 3 times daily for 7 days) resulted in comparable rates of ocular manifestations relative to oral acyclovir (800 mg 5 times daily for 7 days). According to provincial drug formulary data, famciclovir and valacyclovir are more affordable across Canada with the recommended dosing schedules. CONCLUSIONS: Oral famciclovir and valacyclovir are reasonable alternatives to oral acyclovir for treatment of active HZO in immunocompetent individuals. Their simpler dosing schedules are associated with a cost benefit that is consistent across Canada.

[Activity and cost related to hospital management of herpes zoster in France: focus on ophthalmic herpes zoster]. / Activité hospitalière et coûts liés à la prise en charge du zona en France : focus sur le zona ophtalmique.

OBJECTIVES: Herpes zoster secondary to reactivation and replication of the varicella zoster virus (VZV) caused a painful disease which impact the quality of life. Among the complications, herpes zoster ophtalmicus was responsible to post-herpetic neuralgia and lesions of the ocular globus. The aim of this study is to evaluated the burden and cost of herpes zoster in secondary care in France with focus on herpes zoster ophtalmicus (HZO). METHODS: This retrospective analysis was performed using data extracted from the French medical information system during the year 2012. The diagnosis are coded using the international classification of diseases as primary, related or significant associated diagnosis. RESULTS: During the year 2012, 2,509 patients 50 years old and more were admitted secondary to HZ. Among them, 495 were admitted with an HZO (19.7%). The mean age of patients hospitalized were 77 years. The average cost per stay varied between 3,370 euros and 9,191 euros respectively for zoster without complications and for encephalitis. The overall total hospitalization due to HZ and its complications was around 10.2 million euros in France in 2012, 18% of these costs were attributable to hospitalizations for HZO. CONCLUSION: This study evaluated the cost of hospitalization due to zoster for the French health insurance. This total costs were probably underestimate because the non-exhaustiveness of CIM coding. This study shows the burden of zoster and his cost particularly heavy when ophtalmicus or neurological complications were associated to HZ.