title: The humanistic, economic and societal burden of herpes zoster in Europe: a critical review.
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.
authors.affiliation: Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK. adam.gater@adelphivalues.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Gater
authors.affiliation: Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France. muhart@spmsd.com.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Uhart
authors.affiliation: Adelphi Values, Adelphi Mill, Grimshaw Lane, Bollington, Cheshire, SK10 5JB, UK. rachael.mccool@adelphivalues.com.
authors.forename: Rachael
authors.initials: R
authors.lastname: McCool
authors.affiliation: Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France. epreaud@spmsd.com.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Préaud
mesh_terms: D000328:Adult; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D005260:Female; D006562:Herpes Zoster / Q000191:economics* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged