title: Economic Burden of Herpes Zoster ("culebrilla") in Latin America.
abstract: BACKGROUND
  Herpes zoster (HZ) is characterized by debilitating pain and blistering dermatomal rash. The most common complication of HZ is postherpetic neuralgia (PHN), a persistent pain that can substantially affect patients' quality of life. HZ has significant impact on patients' lives with considerable implications for healthcare systems and society. The purpose of this study was to evaluate the healthcare resource utilization (HCRU) and medical costs associated with HZ in Latin America.
  
  
  METHODS
  We conducted a pooled-analysis of three prospective cohort studies of HZ patients ≥50 years of age in Argentina (n=96); Brazil (n=145) and Mexico (n=142). Patients were recruited at different time-points during their HZ episode and were followed for six months. The incidence of PHN was defined as a worst ZBPI pain score of ≥3, persisting or appearing more than 90 days after the onset of rash. Work effectiveness was measured on a 100-point Likert scale where 100 was described as completely effective (able to work like before HZ began) and 0 as not effective at all. Direct costs included costs due to use of antiviral medications and all medical services used to treat HZ. Indirect cost was based on foregone earnings from patients due to work loss and presenteeism, and work loss by family caretakers. One-way sensitivity analysis was performed to assess the impact on total costs. All costs are reported in 2015 USD currency.
  
  
  RESULTS
  383 HZ patients were included and PHN incidence was 38.6%. The most commonly used resources were visits to the doctor's office (79.1% of patients), the emergency room (48.8%) and a specialist (37.9%); hospitalization was reported for 5.7% of patients. The overall direct cost per case was $763.19 USD, indirect cost was $701.40, for a total of $1,464.59 per HZ episode in Latin America. Total cost associated with HZ in patients with PHN was markedly higher compared to patients without PHN ($2,001.13 vs. $867.72, respectively) with indirect costs accounting for the most part of this difference. The sensitivity analysis was generally robust to changes in the assumptions made.
  
  
  CONCLUSIONS
  HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America.
authors.affiliation: JSS Medical Research, Montreal, QC, Canada. Electronic address: submission@jssresearch.com.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Rampakakis
authors.affiliation: JSS Medical Research, Montreal, QC, Canada.
authors.forename: Clare
authors.initials: C
authors.lastname: Pollock
authors.affiliation: Fundación Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vujacich
authors.affiliation: Geriatrics and Gerontology, Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), Brazil; Núcleo de Pesquisas Clínicas e Envelhecimento (NUPEQ), Unifesp-EPM, São Paulo, Brazil.
authors.forename: Joao
authors.initials: J
authors.lastname: Toniolo Neto
authors.affiliation: Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ortiz Covarrubias
authors.affiliation: Merck Co. & Inc., Latin America Health Outcomes Research, Carolina, Puerto Rico.
authors.forename: Homero
authors.initials: H
authors.lastname: Monsanto
authors.affiliation: Merck Co. & Inc., Center for Observational and Real-World Evidence, Vaccines, Kenilworth, NJ, USA.
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006562:Herpes Zoster / Q000191:economics* / Q000453:epidemiology; D014645:Herpesvirus 3, Human; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D000998:Antiviral Agents
keywords: Herpes zoster; Latin America; burden of disease; healthcare cost