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George S, Carrico J, Hicks KA, Loukov D, Ng C, Regan J, Giannelos N. Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older. PHARMACOECONOMICS - OPEN 2024; 8:481-492. [PMID: 38605257 PMCID: PMC11058134 DOI: 10.1007/s41669-024-00483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion. METHODS A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs). RESULTS The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs CONCLUSIONS RZV is expected to remain a cost-effective option for Canadian adults aged ≥50 years when using longer-term RZV efficacy and waning estimates, although the estimated public health impact was smaller than in the previous analysis (due to lower coverage/completion estimates).
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Lin S, Lin M, Dai Z, Wang F, Lin K, Liu R. Novel Bipolar High-Voltage Pulsed Radiofrequency Targeting the Cervical Sympathetic Chain for Treating Acute Herpetic Neuralgia. Neuromodulation 2023; 26:1808-1816. [PMID: 35088734 DOI: 10.1016/j.neurom.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postherpetic neuralgia (PHN) in the oral, maxillofacial, neck, and upper limb regions is a refractory neuropathic pain and severely affects the quality of life of patients. Because of the absence of ideal treatments for this condition, relieving pain in the acute stage and preventing the occurrence of PHN are of great clinical significance. However, the optimal intervention for this acute herpetic neuralgia remains obscure. OBJECTIVES This study aimed to investigate whether bipolar high-voltage pulsed radiofrequency (PRF) targeting the cervical sympathetic chain could effectively treat acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce the incidence of PHN. MATERIALS AND METHODS A total of 60 patients with acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions were enrolled. The radiofrequency group (n = 30) received bipolar high-voltage PRF under ultrasound guidance at the level of the transverse processes of C6 and C7 to modulate the cervical sympathetic chain. In the sham group (n = 30), the electrodes were simply placed at the same position as in the radiofrequency group, but no radiofrequency energy was applied. The same treatment was repeated in each group after 72 hours. If patients were reported to have a visual analog scale (VAS) score ≥4, they would receive oral tramadol and gabapentin as rescue analgesics. The VAS score, Pittsburgh Sleep Quality Index (PSQI), 36-Item Short Form Health Survey (SF-36) score, use of tramadol and gabapentin, incidence of PHN, and adverse reactions were recorded to assess the effect and safety of therapy during three months of follow-up. RESULTS Decreased VAS scores, PSQI scores, and improved SF-36 scores were detected in the two groups at different time points after treatment (all p < 0.05). The VAS scores, PSQI scores, use of tramadol and gabapentin, and incidence of PHN were significantly lower, whereas the SF-36 scores were significantly higher in the radiofrequency group than in the Sham group (all p < 0.05). No serious adverseness related to the treatment was detected in either group. CONCLUSIONS Bipolar high-voltage PRF treatment targeting the cervical sympathetic chain could effectively relieve acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce PHN incidence. The efficacy and safety of this novel treatment make it worthy of recommendation for clinical application.
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Affiliation(s)
- Shenshen Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Minyi Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Zhisen Dai
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Fengchai Wang
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Kaixing Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Rongguo Liu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province, China.
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Curran D, Doherty TM, Lecrenier N, Breuer T. Healthy ageing: Herpes zoster infection and the role of zoster vaccination. NPJ Vaccines 2023; 8:184. [PMID: 38017011 PMCID: PMC10684688 DOI: 10.1038/s41541-023-00757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023] Open
Abstract
Populations are ageing worldwide, with considerable time lived in ill-health, putting upwards pressure on healthcare budgets. Healthy ageing is defined as maintaining functional ability, including the ability to: meet basic needs; learn, grow and make decisions; be mobile; build and maintain relationships; and contribute to society. The risk and impact of infectious diseases increase with age due to immunosenescence. Vaccination can help to prevent disease in older adults, promoting healthy ageing and active lives. Herpes zoster (HZ) occurs when the varicella zoster virus is reactivated due to declining immunity. HZ is common, with a lifetime risk of one-third, and increases in incidence with age. HZ is associated with severe and intense pain, substantially affecting the functional status of patients as well as their overall health-related quality of life. HZ and its complications may result in prolonged morbidity, including persistent pain (post-herpetic neuralgia, PHN), hearing impairment, vision loss and increased risk of stroke and myocardial infarction. HZ and PHN are difficult to treat, substantiating the benefits of prevention. Vaccines to prevent HZ include a recombinant zoster vaccine (RZV). RZV has shown efficacy against the HZ burden of disease and HZ burden of interference on activities of daily living of over 90% in immunocompetent adults aged ≥50 years. Vaccine efficacy against HZ was maintained at over 70% at 10 years post-vaccination. Adult vaccination, including against HZ, has the potential to reduce burden of disease, thus helping to maintain functioning and quality of life to support healthy ageing in older adults.
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Gao N, Li M, Wang W, Wang L, Liu Z, Guo Y. Top 100 Most-Cited Papers in Herpes Zoster from 2000 to 2022: A Bibliometric Study. J Pain Res 2023; 16:1779-1797. [PMID: 37273270 PMCID: PMC10237222 DOI: 10.2147/jpr.s409616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
Background In recent years, the incidence of herpes zoster has risen steeply, the exact pathogenesis of the acute pain and the transformation into postherpetic neuralgia are still obscure, and the absence of effective management remains a major therapeutic challenge. The purpose of this study was to perform a qualitative and quantitative bibliometric analysis of the 100 most cited papers on herpes zoster. Materials and methods Related literature were retrieved from the Web of Science Core Collection. Excel and VOSviewer software were applied to quantitatively analyze, and construct the bibliometric network charts. Results The Top 100 most-cited papers published between 2000 and 2018 showed a fluctuating downward trend. The most studies were published in the year of 2000 (n = 12). The article entitled "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults" from Oxman MN, was the most-cited publication. The United States was the most contributing country, followed by the United Kingdom, and Italy. Finland occupied the highest citations per publication (CPP). The University of Colorado topped the list of institutions with the most publications with 18 articles and also had the most citations (average citations: 281.78 per article). Myron J Levin from the University of Colorado School of Medicine is the most published and most cited researcher overall, whereas Duke University's John W Gnann tops the list in terms of average CPP. Conclusion In terms of the quantity of T100 articles, researchers, and organizations, the US is the predominant country. The most T100 papers were published in the special journal Clinical Infectious Diseases. The most academic focus remain the remedies for postherpetic neuralgia and vaccine development for individualized groups.
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Affiliation(s)
- Ning Gao
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Meng Li
- Department of Gastroenterology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Weiming Wang
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
| | - Lei Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, 100020, People’s Republic of China
| | - Zhen Liu
- Department of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, People’s Republic of China
| | - Yufeng Guo
- Department of Acupuncture and Moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China
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Galor A, Hamrah P, Haque S, Attal N, Labetoulle M. Understanding chronic ocular surface pain: An unmet need for targeted drug therapy. Ocul Surf 2022; 26:148-156. [PMID: 35970433 DOI: 10.1016/j.jtos.2022.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
Chronic ocular surface pain (COSP) may be defined as a feeling of pain, perceived as originating from the ocular surface, that persists for >3 months. COSP is a complex multifactorial condition associated with several risk factors that may significantly interfere with an individual's daily activities, resulting in poor quality of life (QoL). COSP is also likely to have a high burden on patients with substantial implications on global healthcare costs. While patients may use varied terminology to describe symptoms of COSP, any ocular surface damage in the ocular sensory apparatus (nociceptive, neuropathic, inflammatory, or combination thereof) resulting in low tear production, chronic inflammation, or nerve abnormalities (functional and/or morphological), is typically associated with COSP. Considering the heterogeneity of this condition, it is highly recommended that advanced multimodal diagnostic tools are utilized to help discern the nociceptive and neuropathic pain pathways in order to provide targeted treatment and effective clinical management. The current article provides an overview of COSP, including its multifactorial pathophysiology, etiology, prevalence, clinical presentation, impact on QoL, diagnosis, current management, and unmet medical needs.
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Affiliation(s)
- Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Centre and Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Pedram Hamrah
- Tufts Medical Centre, New England Eye Center, 260 Tremont Street Biewend Building, Boston, MA, USA
| | | | - Nadine Attal
- CHU Paris IdF Ouest - Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, INSERM U 987 and Université Paris Saclay, France
| | - Marc Labetoulle
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France; IMVA-HB/IDMI, CEA, Inserm U1184, 92265, Fontenay-aux-Roses, France.
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KAGESHIMA YUKAKO, INADA EIICHI, YAMAGUCHI KEISUKE, HAYASHIDA MASAKAZU. A Comparison Between Effects of Amenamevir and Famciclovir on Intensities of Acute Pain and the Incidence of Postherpetic Neuralgia in Adult Patients with Herpes Zoster. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:120-130. [PMID: 38912280 PMCID: PMC11189787 DOI: 10.14789/jmj.jmj21-0036-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/07/2022] [Indexed: 06/25/2024]
Abstract
Objective Herpes zoster (HZ) is a common disease, whose most common complication is postherpetic neuralgia (PHN). We conducted this study to compare effects of amenamevir (AMNV) and famciclovir (FCV) on intensities of acute HZ pain and the incidence of PHN, which have not been compared yet. Methods After approval by the Ethics Committee, we retrospectively investigated adult patients with HZ treated with AMNV or FCV at Juntendo University Hospital between October, 2018 and February, 2020. We compared, between 143 AMNV-treated and 131 FCV-treated patients, pain scores of acute HZ pain evaluated on an 11-point numerical rating scale (NRS) and the incidence of PHN with the Mann-Whitney U test and Pearson's chi-square test, respectively. The univariate logistic regression analysis was used to identify predictors of PHN. Results Pain scores during the acute HZ period remained significantly lower in AMNV-treated patients than FCV-treated patients (p = 0.049, 0.011, and 0.016 for Day 3-4, Day 7, and Week 2-3, respectively), although the pain score at Day 0 before treatment didn't differ between them (p > 0.05). The incidence of PHN didn't differ between them (9.8% vs. 11.5%, p > 0.05). In the total cohort, the pain score at Week 2-3 was significantly associated with the development of PHN (r 2 = 0.180, p < 0.00001). Conclusions Compared with FCV, AMNV was more effective in reducing acute HZ pain, possibly reflecting its unique mechanism of action. However, AMNV didn't reduce the incidence of PHN possibly due to the multifactorial etiology of PHN.
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Affiliation(s)
- YUKAKO KAGESHIMA
- Corresponding author: Yukako Kageshima, Department of Anesthesiology and Pain Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan, TEL: +81-3-3813-3111 E-mail: .
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Kwan A, Rayes HA, Lazova T, Anderson N, Bonilla D, Su J, Touma Z. Herpes zoster in SLE: prevalence, incidence and risk factors. Lupus Sci Med 2022; 9:9/1/e000574. [PMID: 35017186 PMCID: PMC8753438 DOI: 10.1136/lupus-2021-000574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/16/2021] [Indexed: 11/08/2022]
Abstract
Objectives This study aimed to evaluate the prevalence and incidence of herpes zoster (HZ) events and describe its associated factors in a study of patients with SLE. Methods 491 consecutive SLE participants were screened for HZ events using a patient-reported questionnaire to capture outcomes on pain and other characteristics associated with HZ events. Sociodemographic, clinical and laboratory measures were also analysed, and time-dependent Cox regression survival analyses were performed to investigate factors associated with HZ events. Results Prevalence of HZ was 30.5%, incidence was 14.3 cases per 1000 person-years. Lymphopenia and glucocorticoid dosing were significantly associated with HZ events. Conclusions HZ is highly prevalent in SLE, which may be linked to disease-related and treatment-related effects on cellular immunity. Our results suggest that the presence of certain risk factors may be useful to allow identification of patients at risk of HZ and improve its management in patients with SLE.
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Affiliation(s)
- Andrew Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hanan Al Rayes
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, Riyadh, Saudi Arabia
| | - Tijana Lazova
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Nicole Anderson
- Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Dennisse Bonilla
- Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, Ontario, Canada
| | - Zahi Touma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada .,Department of Medicine, Division of Rheumatology, University Health Network, Toronto, Ontario, Canada
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Flem E, Graham J, Yi Z, Wisløff T, Johnson KD. Cost and health impact analysis of herpes zoster vaccination in Norway. Expert Rev Pharmacoecon Outcomes Res 2021; 22:315-326. [PMID: 34488508 DOI: 10.1080/14737167.2021.1973893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A decision analytic model was developed to estimate the cost-effectiveness of a national vaccination program against herpes zoster in Norway. METHODS The model analyzed six vaccination scenarios that included the live-attenuated zoster vaccine under different target ages of vaccination (60, 65, and 70 years) compared with no vaccination. A catch-up program implemented in the first year of the vaccination was included in three of the scenarios. The model followed the population of Norway over a 40-year time horizon to estimate costs and outcomes associated with vaccination. Immunization costs, costs related to herpes zoster (both healthcare sector and non-healthcare sector), the quality of life gains due to avoided cases of herpes zoster, and quality-of-life losses due to vaccine-related adverse events were estimated. RESULTS AND CONCLUSIONS A national vaccination program would result in reduction of the number of herpes zoster cases and decreased burden of illness. Vaccinating adults at 65 years of age with catch-up up to 70 years in the first year of the program was the most cost-effective strategy with the incremental cost per quality-adjusted life-year gained at NOK (Norwegian Krone) 245,459 from the societal perspective and NOK 248,637 from the health care system perspective.
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Affiliation(s)
- Elmira Flem
- Medical Affairs, Merck Sharp & Dohme Corp, Drammen, Norway
| | - Jonathan Graham
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Zinan Yi
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Torbjørn Wisløff
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Kelly D Johnson
- Merck & Co., Inc, Center for Observational and Real-World Evidence (CORE), Kenilworth, New Jersey, USA
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Schmader KE, Levin MJ, Chen M, Matthews S, Riley ME, Woo W, Hervé C, Grupping K, Schuind AE, Oostvogels L, Curran D. Impact of Reactogenicity After Two Doses of Recombinant Zoster Vaccine Upon Physical Functioning and Quality of Life: An Open Phase III Trial in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:485-490. [PMID: 32530462 PMCID: PMC7907492 DOI: 10.1093/gerona/glaa127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Herpes zoster may significantly impact quality of life (QoL) in older adults. The recombinant zoster vaccine (RZV) is efficacious in adults aged ≥50 and older and is associated with increased reactogenicity compared to placebo. We report here on the impact of reactogenicity of the second RZV dose on the QoL and physical functioning (PF) of vaccine recipients, and summarize findings following both doses. METHOD In this single-arm study, 401 adults aged ≥50 and older were enrolled to receive two RZV doses 2 months apart. Change in mean Short Form Survey-36 (SF-36) PF and EuroQol-5 Dimension (EQ-5D) scores, reactogenicity, safety, productivity loss, and healthcare resource utilization were evaluated. RESULTS In total, 391 (97.5%) participants received dose 2. Post-dose 2, the most common solicited local symptoms were injection site pain (75.1%), erythema (22.4%), and swelling (13.9%), and the most common systemic symptoms were fatigue (46.3%), headache (37.5%), and myalgia (32.9%). Grade 3 solicited (local and systemic) adverse events were reported by 61 (15.6%) participants and were associated with a transient clinically significant decrease in SF-36 PF score on Days 1-2 post-dose 2 that recovered by Day 3. Overall, no clinically important reduction in mean SF-36 PF scores was observed from baseline to post-dose 2 (mean change -0.4), and no quality-adjusted-life-year loss was recorded. CONCLUSIONS Overall, QoL and PF of RZV vaccinees were not affected by vaccine-related reactogenicity. A transient reduction was observed in the first 2 days after RZV vaccination in individuals with Grade 3 adverse events. No safety concerns were identified.
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Affiliation(s)
- Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, North Carolina
| | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Gao HX, Zhang JJ, Liu N, Wang Y, Ma CX, Gao LL, Liu Q, Zhang TT, Wang YL, Bao WQ, Li YX. A fixed nitrous oxide/oxygen mixture as an analgesic for patients with postherpetic neuralgia: study protocol for a randomized controlled trial. Trials 2021; 22:29. [PMID: 33407845 PMCID: PMC7787626 DOI: 10.1186/s13063-020-04960-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pain management of postherpetic neuralgia (PHN) remains a major challenge, with no immediate relief. Nitrous oxide/oxygen mixture has the advantages of quick analgesic effect and well-tolerated. The purpose of this study is to investigate the analgesic effect and safety of nitrous oxide/oxygen mixture in patients with PHN. METHODS/DESIGN This study is a single-center, two-group (1:1), randomized, placebo-controlled, double-blind clinical trial. A total of 42 patients with postherpetic neuralgia will be recruited and randomly divided into the intervention group and the control group. The control group will receive routine treatment plus oxygen, and the intervention group will receive routine treatment plus nitrous oxide/oxygen mixture. Data collectors, patients, and clinicians are all blind to the therapy. The outcomes of each group will be monitored at baseline (T0), 5 min (T1), and 15 min (T2) after the start of the therapy and at 5 min after the end of the therapy (T3). The primary outcome measure will be the pain intensity. Secondary outcomes included physiological parameters, adverse effects, patients' acceptance of analgesia, and satisfaction from patients. DISCUSSION Previous studies have shown that nitrous oxide/oxygen mixture can effectively relieve cancer patients with breakthrough pain. This study will explore the analgesic effect of oxide/oxygen mixture on PHN. If beneficial to patients with PHN, it will contribute to the pain management of PHN. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR1900023730 . Registered on 9 June 2019.
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Affiliation(s)
- Hai-Xiang Gao
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Intensive Care Unit, The Second People’s Hospital of Yinchuan, 684 Bei Jing Street, Yinchuan, 750011 China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Ning Liu
- Department of Pharmacology, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yi Wang
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Chun-Xiang Ma
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Lu-Lu Gao
- School of Public Health and Management, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Qiang Liu
- School of Preclinical Medical Sciences, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Ting-Ting Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yi-Ling Wang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Nursing Department, The First People’s Hospital of Yinchuan, 2 Li Qun Street, Yinchuan, 750004 China
| | - Wen-Qiang Bao
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
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Rafferty ERS, McDonald W, Osgood ND, Doroshenko A, Farag M. What We Know Now: An Economic Evaluation of Chickenpox Vaccination and Dose Timing Using an Agent-Based Model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:50-60. [PMID: 33431153 DOI: 10.1016/j.jval.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/03/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The value of chickenpox vaccination is still debated in the literature and by jurisdictions worldwide. This uncertainty is reflected in the inconsistent uptake of the vaccine, where some countries offer routine childhood immunization programs, others have targeted programs, and in many the vaccine is only privately available. Even across the countries that have universal funding for the vaccine, there is a diversity of schedules and dosing intervals. Using an agent-based model of chickenpox and shingles, we conducted an economic evaluation of chickenpox vaccination in Alberta, Canada. METHODS We compared the cost-effectiveness of 2 common chickenpox vaccination schedules, specifically a long dosing interval (first dose: 12 months; second dose: 4-6 years) and a short dosing interval (first dose: 12 months; second dose: 18 months). RESULTS The economic evaluation demonstrated a shorter dosing interval may be marginally preferred, although it consistently led to higher costs from both the societal and healthcare perspectives. We found that chickenpox vaccination would be cost-saving and highly cost-effective from the societal and healthcare perspective, assuming there was no impact on shingles. CONCLUSION Chickenpox vaccine was cost-effective when not considering shingles and remained so even if there was a minor increase in shingles following vaccination. However, if chickenpox vaccination did lead to a substantial increase in shingles, then chickenpox vaccination was not cost-effective from the healthcare perspective.
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Affiliation(s)
- Ellen R S Rafferty
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada.
| | - Wade McDonald
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathaniel D Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander Doroshenko
- Faculty of Medicine and Dentistry, Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; School of Public Administration and Development Economics, Doha Institute for Graduate Studies, Doha, Qatar
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Rondaan C, de Joode AAE, Wang L, Siderius M, Raveling-Eelsing E, van Leer-Buter C, van Assen S, Bos NA, Westra J. Immune response to varicella-zoster virus before and after renal transplantation. Antiviral Res 2020; 183:104938. [PMID: 32979400 DOI: 10.1016/j.antiviral.2020.104938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/29/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Herpes zoster (HZ) risk is high in renal transplant recipients. Vaccination prior to transplantation may provide a useful strategy for the prevention of HZ in the posttranplantation period. However, it is not known whether immunity to varicella-zoster virus (VZV) is affected due to treatment surrounding transplantation. METHODS Both humoral and cellular immunity to VZV were determined prior to and 2-3 years after renal transplantation in 60 adult patients, and 62 matched healthy controls. VZV-specific cellular immunity was measured by an interferon gamma (IFNγ) enzyme-linked immunospot (ELISpot) assay and by analyzing T-cell functionality using flowcytometry. VZV-IgG levels were measured using an in-house glycoprotein enzyme-linked immunosorbent assay (gpELISA). RESULTS Using paired analysis, it was determined that numbers of IFNγ-producing cells did not change after transplantation, but were significantly lower in transplant recipients after transplantation than in controls (p = 0.028). Patients in whom the post-transplant period was complicated by rejection or any acute infection (excluding HZ) had a lower number of IFNγ-producing cells than patients who did not. VZV IgG levels did not differ from controls, but a significant decrease was observed after transplantation (p < 0.0001). CONCLUSIONS VZV-specific cellular immunity, which is essential in the prevention of HZ, did not markedly change in patients following renal transplantation. This suggests that preventive vaccination before transplantation may be beneficial. Our results extend knowledge on VZV immunity after transplantation, vital when considering strategies for the prevention of HZ in these patients.
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Affiliation(s)
- Christien Rondaan
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.
| | - Anoek A E de Joode
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Lei Wang
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Mark Siderius
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Elisabeth Raveling-Eelsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Coretta van Leer-Buter
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Sander van Assen
- Department of Internal Medicine, Division of Infectious Diseases, Treant Care Group, Hoogeveen, the Netherlands
| | - Nicolaas A Bos
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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Aggregate health and economic burden of herpes zoster in the United States: illustrative example of a pain condition. Pain 2019; 161:361-368. [DOI: 10.1097/j.pain.0000000000001718] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yu SY, Fan BF, Yang F, DiBonaventura M, Chen YX, Li RY, King-Concialdi K, Kudel I, Hlavacek P, Hopps M, Udall M, Sadosky A, Cappelleri JC. Patient and economic burdens of postherpetic neuralgia in China. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:539-550. [PMID: 31564930 PMCID: PMC6731977 DOI: 10.2147/ceor.s203920] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Little is known about the patient-reported and economic burdens of postherpetic neuralgia (PHN) among China’s urban population. Methods This noninterventional study was conducted among adults ≥40 years with PHN who were seeking medical care at eight urban hospitals in China. At one study site, patients completed a questionnaire evaluating the patient-reported disease burden (N=185). The questionnaire consisted of validated patient-reported outcomes including the Brief Pain Inventory (BPI), 5-dimension, 3-level EuroQol (EQ-5D-3L), Medical Outcomes Study Sleep Scale, and Work Productivity and Activity Impairment Questionnaire for Specific Health Problems. Questions on non-pharmacologic therapy and out-of-pocket (OOP) expenses were also included. At all study sites, physicians (N=100) completed a structured review of patient charts (N=828), which was used to derive health care resource utilization and associated costs from the societal perspective. Annual costs in Chinese Yuan Renminbi (RMB) for the year 2016 were converted to US dollars (US$). Results Patients (N=185, mean age 63.0 years, 53.5% female) reported pain of moderate severity (mean BPI score 4.6); poor sleep quantity (average of 5.3 hrs per night) and quality; and poorer health status on the EQ-5D-3L relative to the general Chinese population. Respondents also reported average annual OOP costs of RMB 16,873 (US$2541) per patient, mainly for prescription PHN medications (RMB 8990 [US$1354]). Substantial work impairment among employed individuals resulted in annual indirect costs of RMB 28,025 (US$4221). In the chart review, physicians reported that patients (N=828) had substantial health resource utilization, especially office visits; 98% had all-cause and 95% had PHN-related office visits. Total annual direct medical costs were RMB 10,002 (US$1507), mostly driven by hospitalizations (RMB 8781 [US$1323]). Conclusion In urban China, PHN is associated with a patient-reported burden, affecting sleep, quality-of-life, and daily activities including work impairment, and an economic burden resulting from direct medical costs and indirect costs due to lost productivity. These burdens suggest the need for appropriate prevention and management of PHN.
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Affiliation(s)
- Sheng-Yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bi-Fa Fan
- Department of Pain Medicine, Pain Management Centre, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Fei Yang
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | | | - Yu-Xuan Chen
- Pfizer China , Beijing, People's Republic of China
| | - Ruo-Yu Li
- Department of Dermatology, Peking University First Hospital, Beijing, People's Republic of China
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Schmader KE, Levin MJ, Grupping K, Matthews S, Butuk D, Chen M, Idrissi ME, Fissette LA, Fogarty C, Hartley P, Klein NP, Nevarez M, Uusinarkaus K, Oostvogels L, Curran D. The Impact of Reactogenicity After the First Dose of Recombinant Zoster Vaccine on the Physical Functioning and Quality of Life of Older Adults: An Open-Label, Phase III Trial. J Gerontol A Biol Sci Med Sci 2019; 74:1217-1224. [PMID: 30256905 PMCID: PMC6625580 DOI: 10.1093/gerona/gly218] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Herpes zoster and its related complications are associated with significant medical burden, which negatively affects quality of life and daily functioning of the patients. The recently licensed recombinant zoster vaccine (RZV) offers high efficacy but is associated with local and systemic reactions. This study assessed the impact of RZV on the quality of life and daily functioning of participants and implications for caregivers. METHODS Four hundred and one adults aged 50 years or older received single RZV doses at 0 and 2 months in this open-label, single-arm, multicenter study (NCT02979639). Change in mean SF-36 Physical Functioning score following first-dose administration, quality of life, reactogenicity, safety, productivity loss, and health care resource utilization was assessed. The current analysis was performed post-vaccine dose-1; safety follow-up will continue until 1 year post-dose-2. RESULTS The most common solicited local symptoms were injection-site pain (77.5%), redness (23.0%), and swelling (13.3%); the most frequent solicited systemic reactions were fatigue (33.5%), headache (28.3%), and myalgia (26.8%). Grade 3 reactogenicity occurred in 9.5% of participants and was associated with a transient clinically important decrease in SF-36 Physical Functioning score (affecting activities such as walking, carrying groceries, climbing stairs) on Days 1 and 2 post-first vaccination. No clinically meaningful reductions in mean SF-36 Physical Functioning scale scores from pre- to post-RZV dose-1 were observed (mean +1.9 points, primary end point), and no overall quality-adjusted-life-year loss was recorded post-dose-1. Five participants reported lost workdays; caregiver workload was not increased. CONCLUSIONS Overall, the physical functioning and quality of life of older adults were not affected by a first RZV dose. The observed reactogenicity was consistent with previous studies.
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Affiliation(s)
- Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, North Carolina
| | - Myron J Levin
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | | | | | | | | | | | | | | | - Paul Hartley
- Preferred Primary Care Physicians, Uniontown, Pennsylvania
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Max Nevarez
- DaVita Medical Group, Colorado Springs, Colorado
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Carpenter CF, Aljassem A, Stassinopoulos J, Pisacreta G, Hutton D. A Cost-effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-herpetic Neuralgia. Open Forum Infect Dis 2019; 6:ofz219. [PMID: 31289726 PMCID: PMC6602903 DOI: 10.1093/ofid/ofz219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 12/30/2022] Open
Abstract
Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals, accounting for >1 million cases annually in the United States. A live attenuated HZ vaccine (LAV) is Food and Drug Administration approved for those age 50 years or older, though Advisory Committee on Immunization Practices recommendations are only for those age 60 years or older. LAV efficacy is ~70% for persons 50-59 years of age, with lower efficacy in older adults. A new 2-dose adjuvanted subunit vaccine (SUV) has >95% efficacy in persons 50-69 years of age and remains ~90% efficacious in persons vaccinated at age 70 years. Methods To estimate the relative cost-effectiveness of SUV, LAV, and no vaccination (NoV) strategies, a Markov model was developed based on published data on vaccine efficacy, durability of protection, quality of life, resource utilization, costs, and disease epidemiology. The perspective was US societal, and the cycle length was 1 year with a lifelong time horizon. SUV efficacy was estimated to wane at the same rate as LAV. Outcomes evaluated included lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios (ICERs). Results For individuals vaccinated at age 50 years, the ICER for LAV vs NoV was $118 535 per quality-adjusted life-year (QALY); at age 60 years, the ICER dropped to $42 712/QALY. SUV was more expensive but had better ICERs than LAV. At age 50, the ICER was $91 156/QALY, and it dropped to $19 300/QALY at age 60. Conclusions Vaccination with SUV was more cost-effective than LAV in all age groups studied. Vaccination with SUV at age 50 years appears cost-effective, with an ICER <$100 000/QALY.
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Affiliation(s)
- Christopher F Carpenter
- Section of Infectious Diseases, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Annas Aljassem
- Oakland University William Beaumont School of Medicine, Rochester, Michigan.,Department of Physical Medicine and Rehabilitation, Beaumont Health, Royal Oak, Michigan
| | | | | | - David Hutton
- School of Public Health, University of Michigan, Ann Arbor, Michigan
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17
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Tsui E, Cohen EJ. The Importance of Vaccination Against Herpes Zoster. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Johnson KD, Brenneman SK, Newransky C, Sheffler-Collins S, Becker LK, Belland A, Acosta CJ. A cross-sectional survey of work and income loss consideration among patients with herpes zoster when completing a quality of life questionnaire. BMC Health Serv Res 2018; 18:662. [PMID: 30144806 PMCID: PMC6109314 DOI: 10.1186/s12913-018-3451-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/07/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Prior research suggests that many patients do not spontaneously include work/income loss when responding to utility assessments, although this remains unconfirmed in the US due to almost no published US-based studies to date, and has not been previously studied among patients with herpes zoster (HZ). The objective of this study was to examine whether patients with HZ consider work and income loss when completing a quality of life survey. METHODS A cross-sectional survey was administered to 2000 US adult commercial health plan enrollees aged 50-64 years with ≥ 1 HZ medical claim during 2014. The survey collected information related to health status (EQ-5D), work productivity, and HZ severity and clinical features. RESULTS Mean respondent age was 58.4 years [standard deviation (SD) 4.1] and 62.0% were female. About 3 in 4 (76.8%) patients (N = 772) were employed either full (69.9%) or part time (6.9%). Less than half (45%) spontaneously considered work/income loss when responding to EQ-5D, and mean EQ-5D scores for patients who considered work/income loss were lower than for patients who did not [0.56 (SD = 0.28) vs. 0.69 (SD = 0.24); p < 0.001]. Overall, 43% of patients reported at least one full day missed (mean = 9 full days) and 29% reported at least one partial day missed (mean = 6 partial days) during the most recent shingles episode. Patients who considered work loss were more likely to have missed full (76.4% vs 26.0%, p < 0.001) or partial (70.9% vs. 35.2%, p < 0.001) days. Patients with absenteeism were more likely to consider work/income loss when completing EQ-5D [odds ratio (OR) = 7.91, 95% confidence interval (CI) 5.01-12.31]. Odds of absenteeism/presenteeism increased significantly with increasing levels of HZ severity, and higher odds were associated with pain located on the face/scalp/neck/eye/ear (OR 1.90, 95% CI 1.06-3.40) and with pain lasting 12+ months (OR = 2.91, 95% CI 1.14-7.42). CONCLUSIONS HZ has considerable impact on the work and productivity of adults aged 50-64 years old. However, many patients with HZ do not spontaneously consider work/income loss when completing a standardized quality of life questionnaire. Studies that use health state utilities in HZ based on EQ-5D may not fully reflect the societal costs of work loss.
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Affiliation(s)
- Kelly D. Johnson
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, 351 North Sumneytown Pike, UG2AB-30, North Wales, PA 19454 USA
| | - Susan K. Brenneman
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Chrisann Newransky
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, 351 North Sumneytown Pike, UG2AB-30, North Wales, PA 19454 USA
| | - Seth Sheffler-Collins
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc, 351 North Sumneytown Pike, UG2AB-30, North Wales, PA 19454 USA
| | - Laura K. Becker
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Angela Belland
- Health Economics and Outcomes Research, Optum, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Camilo J. Acosta
- Merck Research Laboratories, 351 North Sumneytown Pike, North Wales, PA 19454 USA
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Lecrenier N, Beukelaers P, Colindres R, Curran D, De Kesel C, De Saegher JP, Didierlaurent AM, Ledent EY, Mols JF, Mrkvan T, Normand-Bayle M, Oostvogels L, Da Silva FT, Vassilev V, Vinals C, Brecx A. Development of adjuvanted recombinant zoster vaccine and its implications for shingles prevention. Expert Rev Vaccines 2018; 17:619-634. [PMID: 30028651 DOI: 10.1080/14760584.2018.1495565] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION GSK has developed a two-dose adjuvanted recombinant zoster vaccine (Shingrix, RZV) to protect people aged ≥50 years (50+) against herpes zoster (HZ) and its complications. RZV showed >90% efficacy against HZ, sustained over 4 years of follow-up, in all studied age groups. AREAS COVERED This article reviews the scientific rationale underlying the design of RZV; the clinical evidence demonstrating immunogenicity, safety, and efficacy in persons 50+; and the public health implications and cost-effectiveness. EXPERT COMMENTARY A decline in varicella zoster virus (VZV) immunity is associated with increased risk of HZ in adults 50+ and immunocompromised individuals. RZV was designed to restore levels of anti-VZV cellular and humoral immunity to prevent VZV reactivation. RZV includes the recombinant gE glycoprotein antigen, and Adjuvant System AS01B which promotes cellular and antibody responses. In two Phase III studies in subjects aged 50+ and 70+ years, RZV efficacy against HZ compared to placebo was >90% and ≥89% against post-herpetic neuralgia (PHN). RZV is expected to dramatically impact HZ morbidity including its complications, and associated health-care costs. In the US population aged 50+ years, vaccination with RZV can be cost-effective compared to no vaccination and cost-saving compared to the currently available live-attenuated HZ vaccine (Zostavax, Merck).
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20
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Determining the optimal strategy for the live-attenuated herpes zoster vaccine in adults. Vaccine 2018; 36:6237-6247. [PMID: 30031663 DOI: 10.1016/j.vaccine.2018.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
The optimal strategy for the vaccinating against herpes zoster (HZ) vaccine remains unknown. Cost-effectiveness analyses provide insight to the most cost-effective age groups but results vary across studies. The optimal strategy is important given that vaccine efficacy and duration vary depending on vaccination age. Therefore, small changes from the optimal age can affect long-term outcomes and produce sub-optimal results. The objective of this research was to determine the optimal timing policy for HZ vaccination. We simulated cohorts of men and women and use stochastic dynamic programming to evaluate the decision to vaccinate or defer each year from age 50 to 100. If the decision was to defer, the cohort risked developing HZ. If HZ occurred, the cohort was subjected to cost and quality-adjusted life year (QALY) loss for a typical HZ infection (including complications) at that age. If HZ did not occur, the decision was evaluated at the next age. Then, we extend the model to consider the case in which a booster vaccine is available. A set of probabilistic sensitivity analyses were conducted to check model robustness. Results show the optimal policy for women is to vaccinate between ages 66 and 77, and for men between ages 66 and 74, assuming a willingness to pay (WTP) of $100,000 per QALY. It becomes optimal to vaccinate earlier if a booster vaccine is available, and women have a wider range of ages than men. This research is the first to examine exactly when the HZ vaccine should be administered. It is also the first study, to our knowledge, that used stochastic dynamic programming to examine the question of a second dose for any vaccine. This research provides the first simple policy on when to vaccinate and re-vaccinate against HZ.
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Abstract
IMPORTANCE The live attenuated herpes zoster vaccine (ZVL) is recommended for immunocompetent adults 60 years or older, but the efficacy wanes with age and over time. A new adjuvanted herpes zoster subunit vaccine (HZ/su) has higher efficacy but might be more expensive. The choice of vaccines depends on their relative values. OBJECTIVE To assess the cost-effectiveness of HZ/su. DESIGN, SETTING, AND PARTICIPANTS Markov decision model with transition probabilities based on the US medical literature. Participants were immunocompetent adults 60 years or older. Data were derived from participant groups ranging in number from less than 100 to more than 30 000 depending on the variable assessed. The study dates were July 1 to 31, 2017. EXPOSURES No vaccination, ZVL (single dose), and HZ/su (2-dose series) vaccine administered at different ages. MAIN OUTCOMES AND MEASURES Total costs and quality-adjusted life-years (QALYs) were estimated. RESULTS Based on randomized clinical trial data, at a price of $280 per series ($140 per dose), HZ/su was more effective and less expensive than ZVL at all ages. The incremental cost-effectiveness ratios compared with no vaccination ranged from $20 038 to $30 084 per QALY, depending on vaccination age. The finding was insensitive to variations in most model inputs other than the vaccine price and certain combinations of low adherence rate with a second dose and low efficacy of a single dose of HZ/su. At the current ZVL price ($213 per dose), HZ/su had lower overall costs than ZVL up to a price of $350 per 2-dose series. In probabilistic sensitivity analysis, HZ/su had 73% probability of being cost-effective for 60-year-olds at $50 000 per QALY. CONCLUSIONS AND RELEVANCE Under conservative assumptions, at a price of $280 per series ($140 per dose), HZ/su would cost less than ZVL and has a high probability of offering good value.
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Affiliation(s)
- Phuc Le
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Rondaan C, van der Geest KSM, Eelsing E, Boots AMH, Bos NA, Westra J, Brouwer E. Decreased Immunity to Varicella Zoster Virus in Giant Cell Arteritis. Front Immunol 2017; 8:1377. [PMID: 29118757 PMCID: PMC5661055 DOI: 10.3389/fimmu.2017.01377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/06/2017] [Indexed: 12/16/2022] Open
Abstract
Introduction Herpes zoster, which can have a major impact on quality of life, results from reactivation of a latent varicella zoster virus (VZV) infection. We hypothesized that giant cell arteritis (GCA) patients are at increased risk of herpes zoster because of treatment with high-dose glucocorticoids and advanced age. Aim of the study, therefore, was to determine cell-mediated and humoral immunity to VZV in patients with GCA, patients with closely related disease polymyalgia rheumatica (PMR; treated with lower doses of glucocorticoids) and healthy controls (HCs). Methods Cell-mediated immunity to VZV was determined by performing interferon-γ (IFNγ) enzyme-linked immunospot and intracellular cytokine flow cytometry measurements in 11 GCA and 15 PMR patients and in 26 age/sex-matched HCs. Immunoglobulin G antibodies to VZV glycoprotein (VZV-IgG) were measured in serum samples of 35 GCA and 26 PMR patients at different times of follow-up and in 58 age and sex-matched HCs by an enzyme-linked immunosorbent assay. Results The number of VZV-specific IFNγ spot-forming cells was significantly lower in GCA patients on treatment, than in age-matched HCs (p = 0.029), but was not different in PMR patients on treatment. Similar levels of VZV-IgG were found in GCA and PMR patients at baseline, compared to HCs. Conclusion The finding of a decreased cell-mediated immunity to VZV, known to be of great importance in defense to the virus, indicates an increased herpes zoster risk in GCA patients compared to an already at-risk elderly population. Herpes zoster vaccination is, therefore, of special importance in GCA patients, and would ideally be administered at time of diagnosis. Interestingly, as VZV was suggested to be the trigger in GCA pathogenesis, similar levels of VZV-IgG were found in GCA patients at time of diagnosis and age-matched HCs, indicating that GCA patients did not experience herpes zoster substantially more often in the months preceding diagnosis than controls.
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Affiliation(s)
- Christien Rondaan
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Elisabeth Eelsing
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Annemieke M H Boots
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Nicolaas A Bos
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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Gabutti G, Bonanni P, Conversano M, Fanelli G, Franco E, Greco D, Icardi G, Lazzari M, Rossi A, Scotti S, Volpi A. Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience. Hum Vaccin Immunother 2017; 13:391-398. [PMID: 27925894 PMCID: PMC5328234 DOI: 10.1080/21645515.2017.1264831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Herpes zoster (HZ) is an acute viral illness characterized by a vesicular rash with unilateral distribution, which can also result in severe complications such as post-herpetic neuralgia (PHN), ophthalmic zoster, stroke or other neurological complications. The estimate incidence in Europe ranges between 2.0 and 4.6 cases per 1,000 person-years, with a sharp increase in >50 year-old subjects. Currently, treatment options for HZ are only partially effective in limiting the acute phase, while the management of complications is complex and often unsatisfactory. The total burden of the disease and the high costs related to its diagnostic and therapeutic management led researchers to develop a new preventive approach through a live attenuated virus vaccine. The currently available vaccine, with a high antigen content, is safe, well tolerated and reduces the incidence of HZ, PHN and the burden of illness. Several countries have introduced this vaccination, albeit with different recommendations and methods of financing. Taking into account the barriers to this immunization registered in some areas (difficulty of vaccine distribution, lack of physician recommendations, the cost of vaccine for patients, etc.), this group of Italian experts advocate that a common strategy able to guarantee a good compliance with this vaccination should be implemented. The same group addresses some practical questions concerning the use of zoster vaccine.
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Rampakakis E, Stutz M, Kawai K, Tsai TF, Cheong HJ, Dhitavat J, Ortiz-Covarrubias A, Cashat-Cruz M, Monsanto H, Johnson KD, Sampalis JS, Acosta CJ. Association between work time loss and quality of life in patients with Herpes Zoster: a pooled analysis of the MASTER studies. Health Qual Life Outcomes 2017; 15:11. [PMID: 28100258 PMCID: PMC5242047 DOI: 10.1186/s12955-017-0588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/12/2017] [Indexed: 12/04/2022] Open
Abstract
Background Herpes zoster (HZ) has a significant negative effect on the productive work life of individuals, and has been shown to be responsible for cases of absenteeism, presenteeism and decreased work effectiveness. The aim of this study was to evaluate health utility scores and associated predictors in an actively employed population of Herpes Zoster (HZ) patients with and without work time loss (WTL). Methods This was a pooled analysis of the prospective, observational MASTER cohort studies, conducted in 8 countries across North America, Latin America and Asia. A total of 428 HZ patients engaged in full or part time work were included. WTL, defined as missing ≥ 1 partial or full work day, and work effectiveness, reported on a scale of 0–100%, were evaluated with the Work and Productivity Questionnaire (WPQ). The Pearson product–moment correlation was used to assess the correlation between work effectiveness and HRQoL. Mixed models with repeated measures assessed the relationship between HZ-related WTL over a 6-month follow-up period, and HRQoL, as evaluated by the EQ-5D. Additional predictors of HRQoL were also identified. Results Overall, 57.7% of respondents reported WTL. Mean (SD) percent work effectiveness of patients in the WTL group was significantly lower compared to non-WTL (NWTL) patients at baseline [50.3 (31.6) vs. 71.4 (27.8); p < 0.001]. Patients in the WTL group also reported lower health utility scores at baseline and overall than their NWTL counterparts, with WTL identified as an independent negative predictor of both the EQ-5D summary scores and the EQ-5D VAS (p < 0.001). Decrease in work effectiveness was negatively associated with HRQoL overall (p < 0.001). Predictors of lower HRQoL were worst Zoster Brief Pain Inventory (ZBPI) pain score, the presence of HZ complications and country income (predictor of EQ-5D VAS only). Conclusions HZ adversely impacts the work and productive life of actively employed individuals. In turn, HZ-related reductions in work effectiveness and work time are associated with a negative effect on HRQoL. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0588-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Melissa Stutz
- JSS Medical Research, 9400 Henri-Bourassa W, St-Laurent, QC, H4S 1N8, Canada
| | - Kosuke Kawai
- Clinical Research Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei City, 100, Taiwan
| | - Hee Jin Cheong
- Division of Infectious diseases, Department of Internal Medicine, Korea University Guro Hospital, 145 Anam-ro, Seongbuk-gu, Seoul, South Korea
| | - Jittima Dhitavat
- Clinical Infectious Disease Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Alejandro Ortiz-Covarrubias
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Calle Coronel Calderón #777, El Retiro, 44280, Guadalajara, Jalisco, Mexico
| | - Miguel Cashat-Cruz
- Vaccines Latin America & the Caribbean, MSD Corp., Av. San Jerónimo 369 Piso 8, Col. La Otra Banda, Mexico City, CP 01090, Mexico
| | - Homero Monsanto
- Latin America Health Outcomes Research, MSD (I.A.) Corp., P.O. Box 3689, Carolina, PR, 00984-3689, Puerto Rico
| | - Kelly D Johnson
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - John S Sampalis
- JSS Medical Research, 9400 Henri-Bourassa W, St-Laurent, QC, H4S 1N8, Canada. .,McGill University, 845 Sherbrooke Street W, Montreal, QC, H3A 0G4, Canada.
| | - Camilo J Acosta
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
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Li Q, Chen SY, Burstin SJ, Levin MJ, Suaya JA. Cost of Herpes Zoster in Patients With Selected Immune-Compromised Conditions in the United States. Open Forum Infect Dis 2016; 3:ofw067. [PMID: 27419151 PMCID: PMC4943564 DOI: 10.1093/ofid/ofw067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/20/2016] [Indexed: 12/21/2022] Open
Abstract
Among patients with common immune-compromised (IC) conditions in the United States, the healthcare cost associated with herpes zoster (HZ) was sizable and occurred mainly during the first quarter after diagnosis. And HZ-associated costs varied by age and underlying IC conditions. Background. This retrospective study investigates the healthcare costs of herpes zoster (HZ) in patients with selected immune-compromised (IC) conditions in the United States (US). Methods. Patients with incident HZ diagnosis (index date) were selected from nationwide administrative claims databases from 2005 to 2009. Baseline IC groups, analyzed separately, included adults aged 18–64 years with the following: human immunodeficiency virus infection (HIV), solid organ transplant (SOT), bone marrow or stem cell transplant (BMSCT), or cancer; and older adults (aged ≥65 years) with cancer. Herpes zoster patients (n = 2020, n = 1053, n = 286, n = 13 178, and n = 9089, respectively) were 1-to-1 matched to controls without HZ (with randomly selected index date) in the same baseline group. The healthcare resource utilization and costs (2014 US dollars) during the first 2 postindex quarters were compared between matched cohorts with continuous enrollment during the quarter. Results. Herpes zoster patients generally had greater use of inpatient, emergency room and outpatient services, and pain medications than matched controls (P < .05). The incremental costs of HZ during the first postindex quarter were $3056, $2649, $13 332, $2549, and $3108 for HIV, SOT, BMSCT, cancer in adults aged 18–64 years, and cancer in older adults, respectively (each P < .05). The incremental costs of HZ during the second quarter were only significant for adults aged 18–64 years with cancer ($1748, P < .05). The national incremental costs of HZ were projected to be $298 million annually across the 5 IC groups. Conclusions. The healthcare cost associated with HZ among patients with studied IC conditions was sizable and occurred mainly during the first 90 days after diagnosis.
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Affiliation(s)
- Qian Li
- Evidera , Lexington, Massachusetts
| | | | | | - Myron J Levin
- University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
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Préaud E, Uhart M, Böhm K, Aidelsburger P, Anger D, Bianic F, Largeron N. Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany. Hum Vaccin Immunother 2016; 11:884-96. [PMID: 25933182 PMCID: PMC4514364 DOI: 10.1080/21645515.2015.1011561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.
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Key Words
- ASHIP, Association of Statutory Health Insurance Physicians
- CEAC, Cost-effectiveness acceptability curves
- CMI, Cell-mediated immunity
- DSA, Deterministic sensitivity analysis
- EBM, German uniform assessment standard (Einheitlicher Bewertungsmaßstab)
- EMA, European Medicines Agency
- EQ-5D, EuroQoL
- G-DRG, German Diagnosis Related Groups
- GePaRD German Pharmacoepidemiological Research Database
- Germany
- HZ, Herpes zoster
- ICER, Incremental cost-effectiveness ratio
- IQWIG, German Institute for Quality and Efficiency in Health Care
- NNV, Number needed to vaccinate
- PHN, Post-herpetic neuralgia
- PSA, Probabilistic sensitivity analysis
- QALY, Quality-adjusted life year
- SHI, Statutory health insurance
- SPS, Shingles Prevention Study
- STIKO, German Standing Committee on Immunisation
- STPS, Short-Term Persistence Substudy
- US, United States
- VZV, Varizella zoster virus
- YO, Years old
- ZEST, Zostavax® Efficacy and Safety Trial
- cost-effectiveness
- herpes zoster
- mBPI-SF Modified short form brief pain inventory
- markov model
- post-herpetic neuralgia
- vaccination
- zostavax
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Le P, Rothberg MB. Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years. Ann Intern Med 2015; 163:489-97. [PMID: 26344036 DOI: 10.7326/m15-0093] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Each year, herpes zoster (HZ) affects 1 million U.S. adults, many of whom develop postherpetic neuralgia (PHN). Zoster vaccine is licensed for persons aged 50 years or older, but its cost-effectiveness for those aged 50 to 59 years is unknown. OBJECTIVE To estimate the cost-effectiveness of HZ vaccine versus no vaccination. DESIGN Markov model. DATA SOURCES Medical literature. TARGET POPULATION Adults aged 50 years. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION HZ vaccine. OUTCOME MEASURES Number of HZ and PHN cases prevented and incremental cost per quality-adjusted life-year (QALY) saved. RESULTS OF BASE-CASE ANALYSIS For every 1000 persons receiving the vaccine at age 50 years, 25 HZ cases and 1 PHN case could be prevented. The incremental cost-effectiveness ratio (ICER) for HZ vaccine versus no vaccine was $323 456 per QALY. RESULTS OF SENSITIVITY ANALYSIS In deterministic and scenario sensitivity analyses, the only variables that produced an ICER less than $100 000 per QALY were vaccine cost (at a value of $80) and the rate at which efficacy wanes. In probabilistic sensitivity analysis, the mean ICER was $500 754 per QALY (95% CI, $93 510 to $1 691 211 per QALY). At a willingness-to-pay threshold of $100 000 per QALY, the probability that vaccination would be cost-effective was 3%. LIMITATION Long-term effectiveness data for HZ vaccine are lacking for 50-year-old adults. CONCLUSION Herpes zoster vaccine for persons aged 50 years does not seem to represent good value according to generally accepted standards. Our findings support the decision of the Advisory Committee on Immunization Practices not to recommend the vaccine for adults in this age group. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Phuc Le
- From Cleveland Clinic, Cleveland, Ohio
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Postma MJ, Carroll S, Brandão A. The societal role of lifelong vaccination. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2015; 3:26962. [PMID: 27123178 PMCID: PMC4802691 DOI: 10.3402/jmahp.v3.26962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 05/24/2023]
Abstract
The full economic and societal value of vaccination is complex to assess. Although direct protection is the immediate goal of vaccination programmes, it is rare that 100% uptake is attained. An important facet of vaccines value comes from the indirect (or herd) protection they provide. The evolving dynamics of our society, including the increase in the proportion of older individuals enhances the value of indirect protection in reducing disease transmission within the family setting and the society as a whole. For example, grandparents are increasingly involved in childcare, putting them at risk of disease transmission if they or the children are not vaccinated. Preventing disease in children can also reduce absenteeism for parents who otherwise would take days off work to care for their sick children, leading to a substantial societal burden. Preventing disease in working adults reduces absenteeism and presenteeism, enhancing productivity and contributing in turn to economic growth. Quality of life is essential at all ages. It is fundamental in children for their life chances, educational achievements, and healthy wellbeing. Additionally, preventing common diseases in adults and the elderly also contributes to their quality of life and helps to assure healthy ageing for growing ageing populations. These wider economic and societal values, although difficult to measure, should be taken into consideration in assessments of the economic value and cost-effectiveness of vaccination programmes.
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Affiliation(s)
- Maarten J. Postma
- Unit of Pharmaco Epidemiology & Pharmaco Economics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
- Institute of Science in Healthy Aging & Healthcare, University Medical Center Groningen, Groningen, Netherlands
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Abstract
PURPOSE OF REVIEW Infections are important, potentially treatable causes of peripheral nervous system disease. This article reviews the clinical presentation and management of several common peripheral nervous system diseases due to viral, bacterial, spirochetal, and parasitic infections. RECENT FINDINGS The clinical presentation and evaluation of infectious peripheral nervous system diseases are well established. Advances in the treatment and, in some cases, the prevention of these diseases are still evolving. SUMMARY A diverse range of peripheral nervous system diseases, including peripheral neuropathy, radiculopathy, radiculomyelopathy, cranial neuropathy, and motor neuropathy, are caused by numerous infectious agents. In some patients, peripheral neuropathy may be a side effect of anti-infectious drugs. Infectious neuropathies are important to recognize as they are potentially treatable. This article discusses the clinical presentation, evaluation, and treatment of several common peripheral nervous system diseases caused by viral, bacterial, spirochetal, and parasitic infections, as well as some peripheral nerve disorders caused by adverse effects of the treatments of these infectious diseases.
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Nilsson J, Cassel T, Lindquist L. Burden of herpes zoster and post-herpetic neuralgia in Sweden. BMC Infect Dis 2015; 15:215. [PMID: 26002038 PMCID: PMC4493830 DOI: 10.1186/s12879-015-0951-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 05/13/2015] [Indexed: 11/13/2022] Open
Abstract
Background The societal economic burden of herpes zoster in Sweden is not well described today. This study is a top-down analysis of Swedish registers with the objective to describe the burden of herpes zoster and post-herpetic neuralgia in Sweden during 2011. Methods Data for inpatient care; outpatient primary and specialized cares; the prescriptions of drugs, sick leave and the number or diagnostic tests were collected from Swedish national databases. The incidence of the disease was estimated based on the number of prescriptions of antiviral drugs. Results The incidence of herpes zoster was estimated to 315 and 577 cases per 100,000 people for patients at all ages and > = 50 years, respectively. Almost 30,000 patients at all ages were diagnosed with herpes zoster and the societal cost to treat these patients, including the cost to treat those patients who later developed post-herpetic neuralgia, added up to nearly 227 MSEK (31.6 M€) which corresponds to 7,600 SEK (€870) per patient. The main contributors to the total cost for the treatment of HZ patients were primary care (43 %); sick leave (28 %); hospitalization (10 %) and specialist care (7 %). Medication was a relatively small contributor with 8.5 MSEK (4 %; 1.0 M€) to the overall costs for patients at all ages. The corresponding total cost including only patients 50 years and older was 168 MSEK (19.2 M€) or 8,200 SEK (€939) per patient. Conclusions The current study demonstrates that the burden of herpes zoster is significant in Sweden. The society, the health care payers and the patients potentially have a lot to gain by introducing a vaccination program to patients 50 years and older and as a consequence reduce the economic and clinical burden of herpes zoster and post-herpetic neuralgia.
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Affiliation(s)
- Jonas Nilsson
- Mapi Group, Stockholm, Klarabergsviadukten 90D, SE-111 64, Stockholm, Sweden.
| | | | - Lars Lindquist
- Karolinska Institutet, Department of Medicine, Huddinge, Sweden.
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Gater A, Uhart M, McCool R, Préaud E. The humanistic, economic and societal burden of herpes zoster in Europe: a critical review. BMC Public Health 2015; 15:193. [PMID: 25880058 PMCID: PMC4349710 DOI: 10.1186/s12889-015-1514-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/09/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Herpes 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. METHODS Systematic 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. RESULTS From 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. CONCLUSIONS Available 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.
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Affiliation(s)
- Adam Gater
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK.
| | - Mathieu Uhart
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France.
| | - Rachael McCool
- Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK.
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Rondaan C, de Haan A, Horst G, Hempel JC, van Leer C, Bos NA, van Assen S, Bijl M, Westra J. Altered Cellular and Humoral Immunity to Varicella-Zoster Virus in Patients With Autoimmune Diseases. Arthritis Rheumatol 2014; 66:3122-8. [DOI: 10.1002/art.38804] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 07/24/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Christien Rondaan
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Aalzen de Haan
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Gerda Horst
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - J. Cordelia Hempel
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Coretta van Leer
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Nicolaas A. Bos
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Sander van Assen
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - Marc Bijl
- Martini Hospital; Groningen The Netherlands
| | - Johanna Westra
- University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
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Suaya JA, Chen SY, Li Q, Burstin SJ, Levin MJ. Incidence of herpes zoster and persistent post-zoster pain in adults with or without diabetes in the United States. Open Forum Infect Dis 2014; 1:ofu049. [PMID: 25734121 PMCID: PMC4281784 DOI: 10.1093/ofid/ofu049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/27/2014] [Indexed: 11/13/2022] Open
Abstract
We assessed association between diabetes and herpes zoster (HZ) and persistent post-zoster pain (PPZP) in adults. Among 51 million enrollees [~88 million person-years at risk], individuals with diabetes had 45% and 18% higher adjusted risk of HZ and odds of PPZP, respectively. Background This study was designed to assess the association between diabetes and herpes zoster (HZ) and persistent post-zoster pain (PPZP). Methods We used a United States-based, 2005–2009 retrospective observational study of medical and pharmacy claims from adults in 3 large national databases. Incidence rate ratios were used to compare HZ incidence by diabetes status. Multivariate regressions assessed the age and sex-adjusted risk of diabetes on HZ and PPZP as a function of immune competence. National projections of HZ and PPZP cases were obtained. Results Among 51 million enrollees (∼88 million person-years [PYs] at risk), we identified 420 515 HZ cases. Patients with diabetes represented 8.7% of the PYs analyzed but accounted for 14.5% of the HZ cases and 20.3% of the PPZP cases. The crude incidence of HZ was 78% higher (7.96 vs 4.48 cases/1000 PY; P < .01) and the rate of PPZP was 50% higher (5.97% vs 3.93%; P < .01) in individuals with diabetes than without. Individuals with diabetes had 45% higher adjusted risk of HZ (hazard ratio [HR] = 1.45; 95% confidence intervals [CIs], 1.43–1.46) and 18% higher adjusted odds of PPZP (odds ratio = 1.18; 95% CI, 1.13–1.24). The risk of HZ associated with diabetes among immune-compromised individuals was weaker (HR = 1.10; 95% CI, 1.07–1.14) and the risk of PPZP was no longer significant. Every year, approximately 1.2 million HZ cases occur in US adults, 13% of these occur in individuals with diabetes. Conclusions Diabetes is a risk factor for HZ and PPZP in the US adult population. This association is stronger in immune-competent individuals.
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Affiliation(s)
| | | | - Qian Li
- Evidera , Lexington, Massachusetts
| | | | - Myron J Levin
- University of Colorado Denver Anschutz Medical Campus , Aurora
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Chen SY, Suaya JA, Li Q, Galindo CM, Misurski D, Burstin S, Levin MJ. Incidence of herpes zoster in patients with altered immune function. Infection 2013; 42:325-34. [PMID: 24214127 PMCID: PMC3968442 DOI: 10.1007/s15010-013-0550-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/26/2013] [Indexed: 12/05/2022]
Abstract
Purpose To estimate the incidence of herpes zoster (HZ) and rates of post-zoster pain in both the total study population and separately in patients with selected conditions/treatments associated with altered immune function. Methods The health administrative claims databases for commercially insured, Medicare, and Medicaid populations, together accounting for approximately 51 million insured individuals, were analyzed between 2005 and 2009 in a retrospective cohort study. Incidence of HZ episodes per 1,000 person-years (PY) was estimated in all study populations as well as within nine potentially immune-altering conditions. Among patients with HZ, the 6-month rate of persistent post-zoster pain was estimated. Results Analysis of 90.2 million PY at risk revealed that the incidence of HZ in the total study population was 4.82/1,000 PY. The incidence of HZ was highest among patients with bone marrow or stem cell transplant (43.03 %) followed by solid organ transplant, human immunodeficiency virus infection, and systemic lupus erythematosus [95 % confidence interval (CI) 15.19–17.41 %]. HZ incidence rates were higher among persons on immunosuppressants/chemotherapy than among non-users. In the total study population, HZ incidence increased with age (18–49 years: 3.37/1,000 PY; 65+ years: 8.43/1,000 PY; P < 0.01) and female gender (incidence ratio vs. male 1.39, 95 % CI 1.38–1.40 %). The 6-month rate of persistent post-zoster pain was 4.29 % (95 % CI 4.22–4.36 %), which was higher in patients with the selected conditions. Conclusions Despite providing a relatively small fraction of overall HZ cases, persons with immune function-altering conditions make a large contribution to the societal healthcare burden because they have a higher risk of developing HZ and persistent post-zoster pain. These risk factors should be considered in HZ prevention efforts.
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Morant-Talamante N, Diez-Domingo J, Martínez-Úbeda S, Puig-Barberá J, Alemán-Sánchez S, Pérez-Breva L. Herpes zoster surveillance using electronic databases in the Valencian Community (Spain). BMC Infect Dis 2013; 13:463. [PMID: 24094135 PMCID: PMC3851452 DOI: 10.1186/1471-2334-13-463] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiologic data of Herpes Zoster (HZ) disease in Spain are scarce. The objective of this study was to assess the epidemiology of HZ in the Valencian Community (Spain), using outpatient and hospital electronic health databases. METHODS Data from 2007 to 2010 was collected from computerized health databases of a population of around 5 million inhabitants. Diagnoses were recorded by physicians using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). A sample of medical records under different criteria was reviewed by a general practitioner, to assess the reliability of codification. RESULTS The average annual incidence of HZ was 4.60 per 1000 persons-year (PY) for all ages (95% CI: 4.57-4.63), is more frequent in women [5.32/1000PY (95% CI: 5.28-5.37)] and is strongly age-related, with a peak incidence at 70-79 years. A total of 7.16/1000 cases of HZ required hospitalization. CONCLUSIONS Electronic health database used in the Valencian Community is a reliable electronic surveillance tool for HZ disease and will be useful to define trends in disease burden before and after HZ vaccine introduction.
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Affiliation(s)
- Nuria Morant-Talamante
- Vaccine Research Area, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO - Public Health, Valencia, Spain.
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Eilers R, Krabbe PFM, van Essen TGA, Suijkerbuijk A, van Lier A, de Melker HE. Assessment of vaccine candidates for persons aged 50 and older: a review. BMC Geriatr 2013; 13:32. [PMID: 23586926 PMCID: PMC3668232 DOI: 10.1186/1471-2318-13-32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/08/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The increasing life expectancy in most European countries has resulted in growth of the population 50 and older. This population is more susceptible to infectious diseases because of immunosenescence, co-morbidity and general frailty. Thus, to promote healthy aging, vaccination against vaccine-preventable-diseases could be one strategy. In addition to its possible individual benefits, vaccination may also yield social benefits, such as a lower overall cost of healthcare. Most European countries, however, offer only influenza vaccine although vaccines for pneumococcal disease, herpes zoster, pertussis, and hepatitis A are also available. Our aim is to review the knowledge of these vaccines for persons aged 50 and older and explore the arguments for expanding current vaccination programmes beyond just influenza. METHODS The evaluation model of Kimman et al. was used to assess herpes zoster, pneumococcal disease, pertussis and hepatitis A in terms of four domains: pathogen, vaccine, disease outcomes and cost-effectiveness. The sources were Dutch surveillance systems, seroprevalence studies and the international literature. RESULTS Herpes zoster, pneumococcal disease and pertussis are prevalent among persons aged 50 and older. Vaccines vary in effectiveness and have mild and self-limiting side effects. Vaccination against pneumococcal disease and pertussis causes adaptation of the responsible pathogen. For pertussis and hepatitis A, the vaccine is not registered specifically for the elderly population. Vaccination against herpes zoster and pertussis could improve quality of life, while vaccination against pneumococcal disease and hepatitis A prevents mortality. However, only vaccination against herpes zoster and pneumococcal disease appear to be cost-effective. CONCLUSIONS Vaccination can improve the health of the elderly population. As our review shows, however, the data are too incomplete to accurately judge its potential impact. More research is needed to determine how vaccination can most effectively improve the health of the growing population 50 years and older.
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Affiliation(s)
- Renske Eilers
- Department of Epidemiology, University of Groningen, Academic Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven 3720 BA, The Netherlands
| | - Paul FM Krabbe
- Department of Epidemiology, University of Groningen, Academic Medical Center Groningen, P.O. Box 30.001, Groningen 9700 RB, The Netherlands
| | - Ted GA van Essen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
| | - Anita Suijkerbuijk
- Center for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven 3720 BA, The Netherlands
| | - Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven 3720 BA, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, Bilthoven 3720 BA, The Netherlands
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Drolet M, Oxman MN, Levin MJ, Schmader KE, Johnson RW, Patrick D, Mansi JA, Brisson M. Vaccination against herpes zoster in developed countries: state of the evidence. Hum Vaccin Immunother 2013; 9:1177-84. [PMID: 23324598 PMCID: PMC3899157 DOI: 10.4161/hv.23491] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although progress has been made in the treatment of herpes zoster (HZ) and postherpetic neuralgia (PHN), available therapeutic options are only partially effective. Given evidence that a live-attenuated varicella-zoster-virus vaccine is effective at reducing the incidence of HZ, PHN and the burden of illness, policymakers and clinicians are being asked to make recommendations regarding the use of the zoster vaccine. In this report, we summarize the evidence regarding the: (1) burden of illness; (2) vaccine efficacy and safety; and (3) cost-effectiveness of vaccination, to assist evidence-based policy making and guide clinicians in their recommendations. First, there is general agreement that the overall burden of illness associated with HZ and PHN is substantial. Second, the safety and efficacy of the zoster vaccine at reducing the burden of illness due to HZ and the incidence of PHN have been clearly demonstrated in large placebo-controlled trials. However, uncertainty remains about the vaccine's duration of protection. Third, vaccination against HZ is likely to be cost-effective when the vaccine is given at approximately 65 y of age, if vaccine duration is longer than 10 y.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec; Québec, QC Canada; Laval University; Québec, QC Canada
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