Impact of Herpes Zoster and Post-Herpetic Neuralgia on Health-Related Quality of Life in Japanese Adults Aged 60 Years or Older: Results from a Prospective, Observational Cohort Study
Impact of Herpes Zoster and Post-Herpetic Neuralgia on Health- Related Quality of Life in Japanese Adults Aged 60 Years or Older: Results from a Prospective, Observational Cohort Study
Akiko Mizukami 0 1 2 3
Keiko Sato 0 1 2 3
Koichi Adachi 0 1 2 3
Sean Matthews 0 1 2 3
Katsiaryna Holl 0 1 2 3
Taizo Matsuki 0 1 2 3
Toshihiko Kaise 0 1 2 3
Desmond Curran 0 1 2 3
0 Kushiro Dermatology Clinic , Hokkaido , Japan
1 Development and Medical Affairs Division, GSK K.K , GSK Bldg. 6-15, Sendagaya 4-chome, Shibuya-ku, Tokyo 151-8566 , Japan
2 & Akiko Mizukami
3 Health Economics Department , GSK, Wavre , Belgium
Background and Objectives Herpes zoster (HZ) and its most frequent complication, post-herpetic neuralgia (PHN), have been shown to considerably impact quality of life (QoL). This has not yet been demonstrated in Japan. Methods QoL in HZ and PHN patients was evaluated using the Zoster Brief Pain Inventory (ZBPI), EuroQoL-5 Dimension (EQ-5D), Short-Form 12 version 2.0, and shortform McGill Pain Questionnaire up to 270 days after rash onset as part of a prospective, observational, cohort study conducted in Kushiro, Hokkaido, Japan. Results This study involved 412 adults C 60 years of age diagnosed with HZ, 38 of whom developed PHN. QoL in daily activity performance and emotional and physical functioning was impaired at Day 0 (rash onset) and almost resolved by Day 90. Although the mean ZBPI worst pain score for HZ patients without PHN improved from 4.1 at Day 0 to 0.1 at Day 90, the score for HZ patients with PHN at Day 90 was comparable to that for HZ patients without PHN at Day 0. While the EQ-5D score in HZ without PHN improved, on average, from 0.755 to 0.949, the score for HZ with PHN was dependent on PHN duration and did not improve until PHN disappearance.
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Akiko Mizukami and Keiko Sato are co-first authors on this work.
1 Introduction
Herpes zoster (HZ) occurs when varicella-zoster virus
(VZV) reactivates due to waning of cell-mediated
immunity. More than 90% of the Japanese population is infected
with VZV by 20 years of age or older [
1
] and therefore
have a 30% lifetime risk of HZ [
2
]. HZ-related pain
resolves by approximately 90 days for many patients with
HZ, but approximately 20% of them will develop
postherpetic neuralgia (PHN) [
3
], debilitating, long-lasting pain
that can continue for months or years and which therefore
requires long-term pain management.
Annually, approximately 500,000 individuals in Japan
aged 60 years or older develop HZ [
3, 4
], and this number
is expected to increase due to aging of the population, with
an expected increase in the number of patients aged
C 60 years from 40 million (32%) in 2012 to 45 million
(41%) by 2050 [5]. Even with treatment, HZ patients may
experience pain for a prolonged period of time [
6
], and
almost half of HZ patients aged over 70 years were shown
to experience pain persisting for more than 1 year [
7
].
Indeed, the risk of HZ recurrence increases with age [
8
].
A number of studies in different countries reported a
significant negative impact of HZ and PHN on patients’
quality of life (QoL) and that pain experienced due to the
disease interfered with many aspects of the patient’s daily
life [
9–11
]. In addition, the presence of PHN was
associated with a greater impact on most domains of QoL
[
12–15
]. However, to date, data on QoL in HZ patients are
very limited in Japan [16]. Cultural differences have been
known in patient-reported outcomes across countries
[
14, 17
]. Whether similarity or difference in the outcomes
is observed in Japan compared with other countries is not
known. The present study assessed the impact of HZ and
PHN on the QoL of adults aged 60 years or older in Japan.
2 Subjects and Methods
2.1 Study Design
The QoL data were collected as part of a prospective,
observational, multicenter, physician practice-based cohort
study of people aged 60 years or older conducted in Kushiro,
Japan, between June 2013 and February 2015. The details of
the study have been published elsewhere [
18
].
Study participants were recruited among patients
presenting at seven dermatology clinics or hospitals, and HZ
was diagnosed by the physician at the initial consultation or
at a subsequent visit within 7 days of the initial visit. The
maximal duration of the study for each patient was
270 days from the initial visit. At 90 and 180 days after the
initial visit, patients with a pain score of 0 were considered
as having completed the study. PHN was defined by the
presence of HZ-associated pain rated as C 3 in response to
item 3 of the Zoster Brief Pain Inventory (ZBPI)
questionnaire [
19
], persisting or appearing more than 90 days
after onset of the HZ rash. Only HZ patients who were
considered to comply with the protocol requirements (e.g.
complete the booklets by themselves) were included in the
study.
The study is registered at ClinicalTrials.gov
(NCT01873365). It was conducted in accordance with the
Ethic (...truncated)