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.
OBJECTIVES: Recent advances in treatment for chronic hepatitis C (CHC) virus infection have shortened duration of treatment and increased the likelihood of treatment success. To understand what unmet needs remain with available CHC treatments, patient interviews explored what it is like to live with CHC infection and undergo CHC treatment. A subset of interviews also evaluated the content validity and comprehension of patient-reported outcome (PRO) questionnaires for use in CHC clinical trials. METHODS: Sixty-five patients with clinicianconfirmed diagnosis of CHC infection provided informed consent and completed interviews in Germany (n=15), France (n=15), the USA (n=16), and Canada (n=19). Targeted sampling enrolled a demographically and clinically diverse sample. Concept elicitation (CE) interviews (n=58) using in-depth, open-ended questioning encouraged spontaneous discussion of patients' experience of CHC and its treatment. Patients in the USA and Canada also completed cognitive debriefing (CD) interviews using a 'think aloud' protocol to evaluate content validity and comprehension of the Fatigue Severity Scale (FSS, n=34), Work Productivity and Activity Impairment questionnaire for Hepatitis C (WPAI:Hepatitis C, n=7) and the SKINDEX-16 (n=12). Verbatim transcripts were translated to English and analyzed using thematic analysis. RESULTS: Treatment-related symptoms cause a significant burden for patients during treatment with tiredness (60.0%), sleep problems (57.5%), fatigue (50.0%), depression (45.0%) and itchy skin (40.0%) among the most commonly reported symptoms mentioned in CE interviews. In the 40 patients with CHC treatment experience, treatment-related symptoms led to discontinuation or lack of adherence in 25% and 10%, respectively. CD interviews confirmed that the questionnaires were relevant, understandable and easy to complete. Patients suggested minor wording changes that may make these questionnaires easier to complete. CONCLUSIONS: Treatment-related symptoms cause a significant burden for CHC patients and affect their adherence to treatment. The FSS, WPAI:Hepatitis C, and SKINDEX-16 are valid tools for PRO assessment in CHC clinical trials.
Netherlands from a societal perspective. Methods: Health care, patient and family and other use of resources for five different categories of side-effects were measured by means of a questionnaire. Respondents were patients with epilepsy who experienced at least one side-effect due to antiepileptic treatment in the last 12 months. Results: Based on data from 203 chronic epilepsy patients, the overall societal costs of common side-effects in 2012 are estimated to be € 20,751 (CI: 15,196) per patient per year in the base case analysis. These societal costs exist of: mean health care costs (€ 4,458), mean patient and family costs (i.e. informal care and out of pocket expenses) (€ 10,526) and mean other costs (i.e. productivity and daily routine losses) (€ 5,761). Examining the different categories of side-effects separately, ranging from the most to the least expensive category, the cost estimates were as follows: other side-effects (€ 13,228), behavioral side-effects (€ 9,689), general health side-effects (€ 7,454), cognitive side-effects (€ 7,285) and cosmetic side-effects (€ 2,845) per patient per year. Subgroup analyses showed significant differences in costs between patients using monotherapy and those using polytherapy when looking at cognitive and cosmetic side-effects. ConClusions: These estimates should be considered in the overall assessment of the economic impact of a pharmacotherapy.
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