title: Herpes zoster-associated severity and duration of pain, health-related quality of life, and healthcare utilization in Taiwan: a prospective observational study.
abstract: BACKGROUND
  To assess the severity and duration of herpes zoster (HZ)-associated pain (ZAP) and its impact on quality of life (QoL) and healthcare utilization (HCRU) from a patient perspective in routine care in Taiwan.
  
  
  METHODS
  A prospective, observational, single-cohort study was conducted in five centers across Taiwan. Patients were recruited at different time points during their HZ episode and were followed for ≤180 days. ZAP was assessed with the Initial Zoster Impact Questionnaire and the Zoster Brief Pain Inventory, QoL with the EQ-5D, and HCRU with a simple questionnaire.
  
  
  RESULTS
  A total of 150 patients were included with a mean age of 64.9 years and mean time since rash onset of 18.8 days. Prodromal pain was experienced by 64.7% of patients, of whom 91.8% reported moderate-to-severe pain. At enrollment, 98.0% of patients experienced ZAP. Mean ± SD worst pain score decreased from 5.95 ± 3.09 at enrollment to 2.65 ± 2.98 at 30 days and 0.28 ± 0.83 at 180 days. Postherpetic neuralgia was observed in 20.7% of patients. Mean ± SD EQ-5D score significantly decreased (P < 0.001) from 0.91 ± 0.16 before rash onset to 0.67 ± 0.18 after rash onset, showing significant QoL deterioration up to 60 days. The impact of HZ on QoL and pain severity was similar across age groups. Significant HCRU was observed including visits to the doctor (83.3% of patients), specialist (30.7%), emergency department (24.7%), physiotherapist (23.3%), and hospitalizations (20.7%).
  
  
  CONCLUSIONS
  Severe morbidity and significant HCRU are associated with HZ in Taiwan, supporting the need for early intervention and preventive strategies to reduce the HZ-associated burden of illness.
authors.affiliation: Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Tsen-Fang
authors.initials: TF
authors.lastname: Tsai
authors.forename: Chien-An
authors.initials: CA
authors.lastname: Yao
authors.forename: Hsin-Su
authors.initials: HS
authors.lastname: Yu
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Lan
authors.forename: Sheau-Chiou
authors.initials: SC
authors.lastname: Chao
authors.forename: Jen-Hung
authors.initials: JH
authors.lastname: Yang
authors.forename: Kuo-Chia
authors.initials: KC
authors.lastname: Yang
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Ron R
authors.initials: RR
authors.lastname: White
authors.forename: Eliofotisti
authors.initials: E
authors.lastname: Psaradellis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Rampakakis
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kawai
authors.forename: Camilo J
authors.initials: CJ
authors.lastname: Acosta
authors.forename: John S
authors.initials: JS
authors.lastname: Sampalis
mesh_terms: D005260:Female; D006562:Herpes Zoster / Q000150:complications* / Q000628:therapy*; D006801:Humans; D008297:Male; D051474:Neuralgia, Postherpetic / Q000209:etiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013624:Taiwan; D013997:Time Factors