Economic Burden and Impact on Quality of Life of Herpes Zoster in Spanish Adults Aged 50 Years or Older: A Prospective Cohort Study

Javier Díez-Domingo, Desmond Curran, Maria Del Rosario Cambronero, Juan-Antonio Garcia-Martinez, Sean Matthews, Javier Díez-Domingo, Desmond Curran, Maria Del Rosario Cambronero, Juan-Antonio Garcia-Martinez, Sean Matthews

Abstract

Introduction: The economic burden of herpes zoster (HZ), including its most common complication, postherpetic neuralgia (PHN), and its impact on health-related quality of life (HRQL) is not well described in Spain. The aim of this study was to estimate HZ-related healthcare costs and impact on HRQL in Spanish adults aged 50 years or older.

Methods: A prospective, observational study was performed with patients with HZ recruited through four general practitioner networks in Spain (NCT01521286). HRQL data were collected using the EuroQoL-5 Dimension (EQ-5D) questionnaire; HZ-related pain and associated interference with activities of daily living (ADL) were assessed using the Zoster Brief Pain Inventory (ZBPI) questionnaire at days 0 (HZ rash onset), 15, 30, 60, and 90; patients with PHN were assessed up until day 270. Medical resource utilization was recorded throughout study follow-up. Work loss for patients/caregivers was also assessed. Costs were calculated from both the payer and societal perspectives.

Results: A total of 545 patients with Hz were included, of whom 25 developed PHN. During days 0-30 post HZ diagnosis, the mean EQ-5D utility score was 0.738, equating to a utility loss of 0.138. Sleep was the ADL most affected component. The mean costs for HZ in the overall cohort were €240 and €296 from the payer/societal perspective, respectively; €187/€242 for patients with HZ without any HZ-related complications; and €571/€712 for patients who developed PHN. The majority of costs were incurred during days 0-30.

Conclusions: In Spain, HZ and HZ-related complications such as PHN reduce patient HRQL and increase the economic burden for both payers and society in general.

Trail registration: ClinicalTrials.gov identifier NCT01521286.

Keywords: Economic burden; Herpes zoster; Impact; Postherpetic neuralgia; QALY; Quality of life.

Figures

Fig. 1
Fig. 1
ZBPI worst pain score over time until day 90 by PHN status and by age. n number of subjects, PHN postherpetic neuralgia, YOA years of age, ZBPI Zoster Brief Pain Inventory
Fig. 2
Fig. 2
Mean Zoster Brief Pain Inventory (ZBPI) interference with activities of daily living (ADL) over the first 90 days after rash onset
Fig. 3
Fig. 3
Mean EQ-5D utility scores over time by PHN status. EQ-5D EuroQoL-5 Dimension questionnaire, n number of subjects, PHN postherpetic neuralgia
Fig. 4
Fig. 4
Mean costs by payer perspective and complication category (a) and distribution of direct medical costs per herpes zoster episode from the HCS perspective (b) and medical costs and indirect costs from the societal perspective (c). HCS healthcare system, HZ herpes zoster, GP general practitioner, n number of patients, PHN postherpetic neuralgia

References

    1. Cohen JI. Clinical practice: herpes zoster. N Engl J Med. 2013;369:255–263. doi: 10.1056/NEJMcp1302674.
    1. Kawai K, Rampakakis E, Tsai TF, et al. Predictors of postherpetic neuralgia in patients with herpes zoster: a pooled analysis of prospective cohort studies from North and Latin America and Asia. Int J Infect Dis. 2015;34:126–131. doi: 10.1016/j.ijid.2015.03.022.
    1. Katz J, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004;39:342–348. doi: 10.1086/421942.
    1. Coplan PM, Schmader K, Nikas A, et al. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain. 2004;5:344–356. doi: 10.1016/j.jpain.2004.06.001.
    1. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. J Pain. 2005;6:356–363. doi: 10.1016/j.jpain.2005.01.359.
    1. Schmader KE, Sloane R, Pieper C, et al. The impact of acute herpes zoster pain and discomfort on functional status and quality of life in older adults. Clin J Pain. 2007;23:490–496. doi: 10.1097/AJP.0b013e318065b6c9.
    1. Johnson RW, Bouhassira D, Kassianos G, Leplege A, Schmader KE, Weinke T. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med. 2010;8:37. doi: 10.1186/1741-7015-8-37.
    1. Gater A, Abetz-Webb L, Carroll S, Mannan A, Serpell M, Johnson R. Burden of herpes zoster in the UK: findings from the zoster quality of life (ZQOL) study. BMC Infect Dis. 2014;14:402. doi: 10.1186/1471-2334-14-402.
    1. Drolet M, Brisson M, Schmader KE, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. CMAJ. 2010;182:1731–1736. doi: 10.1503/cmaj.091711.
    1. Gater A, Uhart M, McCool R, Preaud E. The humanistic, economic and societal burden of herpes zoster in Europe: a critical review. BMC Public Health. 2015;15:193. doi: 10.1186/s12889-015-1514-y.
    1. Varghese L, Standaert B, Olivieri A, Curran D. The temporal impact of aging on the burden of herpes zoster. BMC Geriatr. 2017;17:30. doi: 10.1186/s12877-017-0420-9.
    1. Pinchinat S, Cebrián-Cuenca AM, Bricout H, Johnson RW. Similar herpes zoster incidence across Europe: results from a systematic literature review. BMC Infect Dis. 2013;13:170. doi: 10.1186/1471-2334-13-170.
    1. Salvetti A, Ferrari V, Garofalo R, et al. Incidence of herpes zoster and postherpetic neuralgia in Italian adults aged >/=50years: a prospective study. Prev Med Rep. 2019;14:100882. doi: 10.1016/j.pmedr.2019.100882.
    1. Schmidt-Ott R, Schutter U, Simon J, et al. Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged >/=50 years: a prospective study. J Infect. 2018;76:475–482. doi: 10.1016/j.jinf.2018.02.001.
    1. Yanni EA, Ferreira G, Guennec M, et al. Burden of herpes zoster in 16 selected immunocompromised populations in England: a cohort study in the Clinical Practice Research Datalink 2000–2012. BMJ Open. 2018;8:e020528. doi: 10.1136/bmjopen-2017-020528.
    1. Muñoz-Quiles C, Lopez-Lacort M, Diez-Domingo J, Orrico-Sanchez A. Herpes zoster risk and burden of disease in immunocompromised populations: a population-based study using health system integrated databases, 2009–2014. BMC Infect Dis. 2020;20:905. doi: 10.1186/s12879-020-05648-6.
    1. Munoz-Quiles C, Lopez-Lacort M, Diez-Domingo J. Risk and impact of herpes zoster among COPD patients: a population-based study, 2009–2014. BMC Infect Dis. 2018;18:203. doi: 10.1186/s12879-018-3121-x.
    1. Morant-Talamante N, Diez-Domingo J, Martinez-Ubeda S, Puig-Barbera J, Aleman-Sanchez S, Perez-Breva L. Herpes zoster surveillance using electronic databases in the Valencian Community (Spain) BMC Infect Dis. 2013;13:463. doi: 10.1186/1471-2334-13-463.
    1. Munoz-Quiles C, Lopez-Lacort M, Orrico-Sanchez A, Diez-Domingo J. Impact of postherpetic neuralgia: a six year population-based analysis on people aged 50 years or older. J Infect. 2018;77:131–136. doi: 10.1016/j.jinf.2018.04.004.
    1. Salleras L, Salleras M, Salvador P, et al. Herpes zoster and postherpetic neuralgia in Catalonia (Spain) Hum Vaccin Immunother. 2015;11:178–184. doi: 10.4161/hv.34421.
    1. Cebrián-Cuenca AM, Diez-Domingo J, San-Martin-Rodriguez M, Puig-Barbera J, Navarro-Perez J, Herpes Zoster Research Group of the Valencian Community Epidemiology and cost of herpes zoster and postherpetic neuralgia among patients treated in primary care centres in the Valencian community of Spain. BMC Infect Dis. 2011;11:302. doi: 10.1186/1471-2334-11-302.
    1. Sicras-Mainar A, Navarro-Artieda R, Ibanez-Nolla J, Perez-Ronco J. Incidence, resource use and costs associated with postherpetic neuralgia: a population-based retrospective study. Rev Neurol. 2012;55:449–461.
    1. Lukas K, Edte A, Bertrand I. The impact of herpes zoster and post-herpetic neuralgia on quality of life: patient-reported outcomes in six European countries. Z Gesundh Wiss. 2012;20:441–451. doi: 10.1007/s10389-011-0481-8.
    1. Curran D, Oostvogels L, Heineman T, et al. Quality of life impact of a recombinant zoster vaccine in adults aged 50 years and older. J Gerontol A Biol Sci Med Sci. 2019;74(8): 1231–8.
    1. Curran D, Schmidt-Ott R, Schutter U, Simon J, Anastassopoulou A, Matthews S. Impact of herpes zoster and postherpetic neuralgia on the quality of life of Germans aged 50 or above. BMC Infect Dis. 2018;18:496. doi: 10.1186/s12879-018-3395-z.
    1. Matthews S, De Maria A, Passamonti M, et al. The economic burden and impact on quality of life of herpes zoster and postherpetic neuralgia in individuals aged 50 years or older in Italy. Open Forum Infect Dis. 2019;6:ofz007. doi: 10.1093/ofid/ofz007.
    1. Mizukami A, Sato K, Adachi K, et al. Impact of herpes zoster and post-herpetic neuralgia on health-related quality of life in Japanese adults aged 60 years or older: results from a prospective observational cohort study. Clin Drug Investig. 2018;38:29–37. doi: 10.1007/s40261-017-0581-5.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. EuroQoL. . Accessed 26 Oct 2020.
    1. Cunningham AL, Lal H, Kovac M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016;375:1019–1032. doi: 10.1056/NEJMoa1603800.
    1. McPhail S, Lane P, Russell T, et al. Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults. Health Qual Life Outcomes. 2009;7:48. doi: 10.1186/1477-7525-7-48.
    1. Chatterji R, Naylor JM, Harris IA, et al. An equivalence study: are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes. 2017;15:18. doi: 10.1186/s12955-017-0596-x.
    1. Badia X, Roset M, Herdman M, Kind P. A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Med Decis Making. 2001;21:7–16. doi: 10.1177/0272989X0102100102.
    1. Consejería de Sanidad y Asuntos Sociales, 17/11/2014 Official Tariffs of Healthcare Services. . Accessed 14 Mar 2019.
    1. BotPLUS web database. Official General Council of the College of Pharmacists of Spain. Madrid. . Accessed 14 Mar 2019.
    1. Gil A, Gil R, Alvaro A, San Martin M, Gonzalez A. Burden of herpes zoster requiring hospitalization in Spain during a seven-year period (1998–2004) BMC Infect Dis. 2009;9:55. doi: 10.1186/1471-2334-9-55.
    1. Garcia I, Portugal C, Chu LH, Kawatkar AA. Response rates of three modes of survey administration and survey preferences of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2014;66:364–370. doi: 10.1002/acr.22125.
    1. Song H, Lee J, Lee M, et al. Burden of illness, quality of life, and healthcare utilization among patients with herpes zoster in South Korea: a prospective clinical-epidemiological study. Int J Infect Dis. 2014;20:23–30. doi: 10.1016/j.ijid.2013.11.018.
    1. Serpell M, Gater A, Carroll S, Abetz-Webb L, Mannan A, Johnson R. Burden of post-herpetic neuralgia in a sample of UK residents aged 50 years or older: findings from the Zoster Quality of Life (ZQOL) study. Health Qual Life Outcomes. 2014;12:92. doi: 10.1186/1477-7525-12-92.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit