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Antiviral Therapies for Herpes Zoster Infections

Are They Economically Justifiable?

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Abstract

Antiviral treatment of herpes zoster is controversial because of uncertain benefits and relatively high costs. Most studies show that antiviral therapy lessens acute herpes zoster symptoms and postherpetic neuralgia (PHN). Current clinical recommendations support antiviral treatment of severely symptomatic herpes zoster in all adults, and mild herpes zoster in those 50 or 60 years of age or older. However, it is unclear if these recommended strategies are cost effective. Published studies of herpes zoster costs and the effect of antiviral therapy on costs and quality of life have significant variation in study design and results, as well as many shortcomings in the data. Thus, definitive economic recommendations cannot be made based on the present data.

Another approach, which we have used, is to develop a ‘reference case’ analysis using decision-analysis techniques and the available data to estimate the incremental cost effectiveness of antiviral treatment in patients of differing age and herpes zoster severity. In the baseline analysis, parameter values and assumptions were consistently slightly biased against antiviral use. Effectiveness was measured in quality-adjusted life years (QALYs).We assumed that antiviral treatment did not change PHN risk, but decreased PHN duration in patients older than 50 years. PHN risk increased with age and with acute herpes zoster severity as seen in published data. Mild acute herpes zoster was assumed to have a utility value of 0.9 and severe acute herpes zoster a value of 0.7 on a scale where 0 = death and 1 = perfect health.

Treating mildly symptomatic acute herpes zoster cost $US89 200/QALY gained in 40-year-olds, $US47 700/QALY in 60-year-olds and $US40 700/QALY in 70- year-olds (1995 values). Results were most sensitive to variation of antiviral costs (baseline $US134), but changes in acute symptom relief, PHN risk, duration, costs and utility, and antiviral effect on PHN duration increased costs/QALY above $US50 000 in 60- and 70-year-olds in extremes of parameter ranges. However, no variation resulted in treatment of mild illness in 40-year-olds to fall below $US50 000/QALY gained.

Treatment of severe acute herpes zoster cost $US29 700, $US18 000 and $US16 500/QALY gained in 40-, 60- and 70-year-olds, respectively. Results were sensitive to variation of antiviral costs (>$US225) and acute symptom relief (<21%) in 40-year-olds.

Based on this analysis, antiviral therapy of herpes zoster seems economically justifiable for mildly symptomatic acute herpes zoster in patients aged 50 years and older, and for severely symptomatic acute herpes zoster in all adults.

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References

  1. Ragozzino MW, Melton LJ, Kurland LT, et al. Population based study of herpes zoster and its sequelae. Medicine 1982; 61: 310–6

    Article  PubMed  CAS  Google Scholar 

  2. Kost RG, Straus SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med 1996; 335: 32–42

    Article  PubMed  CAS  Google Scholar 

  3. Gilden DH. Herpes zoster with postherpetic neuralgia: persisting pain and frustration. N Engl J Med 1994; 330: 932–4

    Article  PubMed  CAS  Google Scholar 

  4. Nikkels AF, Pierard GE. Recognition and treatment of shingles. Drugs 1994; 48: 528–48

    Article  PubMed  CAS  Google Scholar 

  5. Whitley RJ, Gnann JW. Acyclovir: a decade later. N Engl J Med 1992; 327: 782–9

    Article  PubMed  CAS  Google Scholar 

  6. Straus SE. Shingles: sorrows, salves, and solutions. JAMA1993; 269: 1836–9

    Article  PubMed  CAS  Google Scholar 

  7. McKendrick MW, McGill JI, White JE, et al. Oral acyclovir in acute herpes zoster. BMJ 1986; 293: 1529–32

    Article  PubMed  CAS  Google Scholar 

  8. Wood MJ, Ogan PH, McKendrick MW, et al. Efficacy of oral acyclovir treatment of acute herpes zoster. Am J Med 1988; 85: 79–83

    PubMed  CAS  Google Scholar 

  9. Huff JC, Bean B, Balfour HH, et al. Therapy of herpes zoster with oral acyclovir. Am J Med 1988; 85: 84–9

    Article  PubMed  CAS  Google Scholar 

  10. McKendrick MW, McGill JI, White JE, et al. Lack of effect of acyclovir on postherpetic neuralgia [letter].BMJ 1989; 298: 431

    Article  PubMed  CAS  Google Scholar 

  11. Morton P, Thomson AN. Oral acyclovir in the treatment of herpes zoster in general practice. N Z Med J 1989; 102: 93–5

    PubMed  CAS  Google Scholar 

  12. Harding SP, Porter SM. Oral acyclovir in herpes zoster ophthalmicus. Curr Eye Res 1991; 10 Suppl.: 177–82

    Article  PubMed  Google Scholar 

  13. Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 or 21 days with and without prednisone for treatment of acute herpes zoster. N Engl J Med 1994; 330: 896–900

    Article  PubMed  CAS  Google Scholar 

  14. Whitley RJ, Weiss H, Gnann JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized placebo-controlled trial. Ann Intern Med 1996; 125: 376–83

    PubMed  CAS  Google Scholar 

  15. Tyring S, Barbarash RA, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind placebocontrolled trial. Ann Intern Med 1995; 123: 89–96

    PubMed  CAS  Google Scholar 

  16. deGreef H. Famciclovir, a new oral antiherpes drug: results of the first controlled clinical study demonstrating its efficacy and safety in the treatment of uncomplicated herpes zoster in immunocompetent patients. Int J Antimicrob Agents 1995; 4: 241–6

    Article  Google Scholar 

  17. Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy of herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995; 39: 1546–53

    Article  PubMed  CAS  Google Scholar 

  18. Schmader KE, Studenski S. Are current therapies useful for the prevention of postherpetic neuralgia? J Gen Intern Med 1989; 4: 83–9

    Article  PubMed  CAS  Google Scholar 

  19. Silagy C, Gray S. Primary care management of acute herpes zoster: systematic review of evidence from randomized controlled trials. Br J Gen Pract 1995; 45: 39–45

    PubMed  Google Scholar 

  20. Crooks RJ, Jones DA, Fiddian AP. Zoster-associated chronic pain: an overview of clinical trials with acyclovir. Scand J Infect Dis Suppl 1991; 80: 62–8

    PubMed  CAS  Google Scholar 

  21. Wood MJ, Kay R, Dworkin RH, et al. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis 1996; 22: 341–7

    Article  PubMed  CAS  Google Scholar 

  22. Jackson JL, Gibbons R, Meyer G, et al. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: a meta-analysis. Arch Intern Med 1997; 157: 909–12

    Article  PubMed  CAS  Google Scholar 

  23. Johnson R, Mandal B, Bowsher D, et al. Guidelines for the management of shingles: report of a working group of the British Society for the Study of Infection. J Infect 1995; 30: 193–200

    Google Scholar 

  24. Whitley RJ, Weiss HL, Soong SJ, et al. Herpes zoster: risk categories for persistent pain. J Infect Dis 1999; 179: 9–15

    Article  PubMed  CAS  Google Scholar 

  25. Paul JE, Mauskopf JA, Bell L. Cost-consequence models for varicella-zoster virus infections. Pharmacotherapy 1995; 15: 49–58S

    Google Scholar 

  26. Grant DM, Mauskopf JA, Bell L, et al. Comparison of valaciclovir and acyclovir for the treatment of herpes zoster in immunocompetent patients over 50 years of age: a cost consequence model. Pharmacotherapy 1997; 17: 333–41

    PubMed  CAS  Google Scholar 

  27. Huse DM, Schainbaum S, Kirsch AJ, et al. Economic evaluation of famciclovir in reducing the duration of postherpetic neuralgia. Am J Health Syst Pharm 1997; 54: 1180–4

    PubMed  CAS  Google Scholar 

  28. Kubeyinje EP. Cost-benefit of oral acyclovir in the treatment of herpes zoster. Int J Dermatol 1997; 36: 457–9

    Article  PubMed  CAS  Google Scholar 

  29. Smith KJ, Roberts MS. Cost effectiveness of newer antiviral agents: is the evidence spotty? J Infect Dis 1998; 178 Suppl. 1: S85–90

    Article  Google Scholar 

  30. Davies L, Cossins L, Bowsher D, et al. The cost of treatment for post-herpetic neuralgia in the UK. Pharmacoeconomics 1994; 6: 142–8

    Article  PubMed  CAS  Google Scholar 

  31. Gruger J, Backhouse ME. Economic evaluation of antiviral therapy for the treatment of herpes zoster in immunocompetent adults. Pharmacoeconomics 1997; 11: 262–73

    Article  PubMed  CAS  Google Scholar 

  32. Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. New York (NY): Oxford University Press, 1996

    Google Scholar 

  33. Dworkin RH, Portenoy RK. Proposed classification of herpes zoster pain. Lancet 1994; 343: 1648

    Article  PubMed  CAS  Google Scholar 

  34. Pauker SG, Kassirer JP. Decision analysis. N Engl J Med 1987; 316: 250–8

    Article  PubMed  CAS  Google Scholar 

  35. Meltzer D, Johannesson M. Inconsistencies in the ‘societal perspective’ on costs of the Panel on Cost-Effectiveness in Health and Medicine. Med Decis Making 1999; 19: 371–7

    Article  PubMed  CAS  Google Scholar 

  36. Average wholesale price listings. Red Book Update, December 1995. Montvale (NJ): Medical Economics Company, 1995

    Google Scholar 

  37. United States Bureau of Labor Statistics. Average hourly wage of production workers, seasonally adjusted, September 1995. Available from: http://www.bls.gov/eag/eag.us.htm [Accessed 2000 Jun 21]

  38. Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombotic therapy with tissue plasminogen activator as compared with streptokinase of acute myocardial infarction. N Engl J Med 1995; 332: 1418–24

    Article  PubMed  CAS  Google Scholar 

  39. Eisenberg JM. Clinical economics: a guide to the economic analysis of clinical practices. JAMA 1989; 262: 2879–86

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Mercy Hospital of Pittsburgh, 1400 Locust Street, Pittsburgh, Pennsylvania, 15219-5166, USA

    Kenneth J. Smith

  2. Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Mark S. Roberts

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  1. Kenneth J. Smith
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  2. Mark S. Roberts
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Correspondence to Kenneth J. Smith.

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Smith, K.J., Roberts, M.S. Antiviral Therapies for Herpes Zoster Infections. Pharmacoeconomics 18, 95–104 (2000). https://doi.org/10.2165/00019053-200018020-00001

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