Herpes zoster and quality of life

Lydick, Eva; Epstein, Robert S.; Himmelberger, David U.; White, C. J.

doi:10.1212/wnl.45.12_suppl_8.s52

Cited by 118 publications

(93 citation statements)

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“…However, there is a possibility that mild pain may be solicited by questioning and may not be indicative of PHN. Therefore, it can be recommended that only moderate to severe pain be considered as PHN; such pain is more likely to interfere with patients' functioning and have an adverse effect on quality of life (Lydick et al, 1995). Four methodologies for measuring pain severity were discussed: visual analog scales, numerical rating scales, verbal rating scales, and the McGill Pain Questionnaire (Melzack, 1975).…”

Section: What Should Be Assessed?mentioning

confidence: 99%

“…One approach to defining such pain is that pain reported to be three or greater on a 0-10 numerical rating scale. This criterion is based on the results of Lydick et al (1995), in which ratings of acute pain in herpes zoster patients of one or two on a 0-10 scale were rarely accompanied by adverse impacts on quality of life. Two analyses should be conducted: PHN prevalence, assessed as point prevalence of clinically significant pain at three months, and PHN duration, assessed as duration of clinically significant pain in those patients with PHN.…”

Section: Primary Endpointmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of pain in herpes zoster: lessons learned from antiviral trials

et al. 1997

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Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weaknesses examined. Based on this review, recommendations for the design and analysis of future trials of antiviral agents in herpes zoster are proposed. The principal recommendation is that antiviral efficacy should be evaluated both by distinguishing post-herpetic neuralgia from acute pain and by considering pain as a continuum. The primary endpoint should address both the prevalence and duration of post-herpetic neuralgia and should be examined in those patients who have post-herpetic neuralgia. Adopting the proposed recommendations in design and analysis of future trials should facilitate comparison across trials of the efficacy of antiviral agents in the treatment of herpes zoster.

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Section: What Should Be Assessed?mentioning

confidence: 99%

Section: Primary Endpointmentioning

confidence: 99%

Assessment of pain in herpes zoster: lessons learned from antiviral trials

et al. 1997

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“…[3][4][5] However, most HZ cases (>90%) occur in immunocompetent people. 1,2 Herpes zoster can adversely affect a person's health-related quality of life [6][7][8] because of complications such as eye and other nonpain complications 2 as well as acute and chronic pain (postherpetic neuralgia [PHN]) that can result in severe activity limitations and sleep disturbances. 2,6,9 Claims data have been used to estimate the health care utilization (HCU) and cost of HZ in the United States.…”

mentioning

confidence: 99%

Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population

Yawn

Itzler

Wollan

et al. 2009

Mayo Clinic Proceedings

103

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OBJECTIVE:To conduct a population-based study to assess health care utilization (HCU) and costs associated with herpes zoster (HZ) and its complications, including postherpetic neuralgia (PHN) and nonpain complications, in adults aged 22 years and older. PATIENTS AND METHODS:Medical record data on HCU were abstracted for all confirmed new cases of HZ from January 1, 1996, through December 31, 2001, among residents of Olmsted County, Minnesota. Herpes zoster-related costs were estimated by applying the Medicare Payment Fee Schedule to health care encounters and mean wholesale prices to medications. All costs were adjusted to 2006 US dollars using the medical care component of the Consumer Price Index. RESULTS:The HCU and cost of the 1669 incident HZ cases varied, depending on the complications involved. From 3 weeks before to 1 year after initial diagnosis, there were a mean of 1.8 outpatient visits and 3.1 prescribed medications at a cost of $720 for cases without PHN or nonpain complications compared with 7.5 outpatient visits and 14.7 prescribed medications at a cost of $3998 when complications, PHN, or nonpain complications were present. CONCLUSION:The annual medical care cost of treating incident HZ cases in the United States, extrapolated from the results of this study in Olmsted County, is estimated at $1.1 billion. Most of the costs are for the care of immunocompetent adults with HZ, especially among those 50 years and older. © 2009 Mayo Foundation for Medical Education and ResearchN early 1 million new cases of herpes zoster (HZ) occur annually in the United States. 1,2 Herpes zoster results from reactivation of the varicella-zoster virus, which remains dormant after infection with chickenpox. Declining cellular immunity associated with aging and immunocompromising conditions increase the risk of HZ and HZ complications. [3][4][5] However, most HZ cases (>90%) occur in immunocompetent people. 1,2 Herpes zoster can adversely affect a person's health-related quality of life 6-8 because of complications such as eye and other nonpain complications 2 as well as acute and chronic pain (postherpetic neuralgia [PHN]) that can result in severe activity limitations and sleep disturbances. 2,6,9 Claims data have been used to estimate the health care utilization (HCU) and cost of HZ in the United States. 10,11 However, such data have potential limitations. Claims data may not capture all the HCU and costs attributable to the complications of HZ, including PHN and nonpain complications. In the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), 12 few HZ complication-specific diagnostic codes are available, and they may not be used reliably. Although there is an ICD-9-CM diagnostic code for PHN, there is no standard definition for PHN that is used by all physicians. In addition, not all HZ-related visits are coded with a zosterspecific diagnostic code, especially visits that occur before definitive diagnosis. Medications, laboratory tests, and procedures are not directly linke...

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“…There is a case for the inclusion of an overall quality-of-life measure, since recent evidence confirms that the impact of zoster on wellbeing is considerable (Lydick et al, 1994). Given the difficulties of interpreting the severity of pain (see above), a patient questionnaire scoring the impact of pain on life is the most satisfactory way of assessing 'clinically significant pain'.…”

Section: Quality Of Lifementioning

confidence: 99%

How should zoster trials be conducted?

Balfour²,

Beutner³

et al. 1995

J Antimicrob Chemother

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In 1994, an international group of interested clinicians and biostatisticians met to discuss the design of clinical trials in herpes zoster. They agreed that trials in herpes zoster should have prospectively agreed definitions of all outcome measures and plans for data analysis. In immunocompetent individuals, in whom pain is the major outcome measure, trials should only include patients over the age of 50 years, and for those recruited within 72 h of rash onset, should be designed to demonstrate superiority of any new therapy over existing antivirals. The primary endpoint should be time to cessation of pain for at least 4 weeks and, for the purposes of statistical analysis of its duration, the pain associated with herpes zoster ought to be considered as a continuum. All other variables, including the incidence of post-herpetic neuralgia and effects upon quality of life should be considered as secondary end-points. Evaluation of treatment effects on primary endpoints should be based upon an intent-totreat (ITT) analysis and subgroup analysis should be used only to support the findings of the ITT analysis. These elements of good study design should be borne in mind in the evaluation of current and future trails of antiviral drugs in herpes zoster.

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Herpes zoster and quality of life

Cited by 118 publications

References 1 publication

Assessment of pain in herpes zoster: lessons learned from antiviral trials

Assessment of pain in herpes zoster: lessons learned from antiviral trials

Health Care Utilization and Cost Burden of Herpes Zoster in a Community Population

How should zoster trials be conducted?

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