Community and patient values for preventing herpes zoster.
ABSTRACT The US Advisory Committee on Immunization Practices has recently recommended a new vaccine against herpes zoster (shingles) for routine use in adults aged > or =60 years. However, estimates of the cost effectiveness of this vaccine vary widely, in part because of gaps in the data on the value of preventing herpes zoster. Our aims were to (i) generate comprehensive information on the value of preventing a range of outcomes of herpes zoster; (ii) compare these values among community members and patients with shingles and post-herpetic neuralgia (PHN); and (iii) identify clinical and demographic characteristics that explain the variation in these values.
Community members drawn from a nationally representative survey research panel (n = 527) completed an Internet-based survey using time trade-off and willingness-to-pay questions to value a series of scenarios that described cases of herpes zoster with varying pain intensities (on a scale of 0 to 10, where 0 represents no pain and 10 represents the worst imaginable pain) and duration (30 days to 1 year). Patients with shingles (n = 382) or PHN (n = 137) [defined as having symptoms for > or =90 days] from two large healthcare systems completed telephone interviews with similar questions to the Internet-based survey and also answered questions about their current experience with herpes zoster. We constructed generalized linear mixed models to evaluate the associations between demographic and clinical characteristics, the length and intensity of the health states and time trade-off and willingness-to-pay values.
In time trade-off questions, community members offered a mean of 89 (95% CI 24, 182) discounted days to avoid the least severe scenario (pain level of 3 for 1 month) and a mean of 162 (95% CI 88, 259) discounted days to avoid the most severe scenario (pain level of 8 for 12 months). Compared with patients with shingles, community members traded more days to avoid low-severity scenarios but similar numbers of days to avoid high-severity scenarios. Compared with patients with PHN, community members traded fewer days to avoid high-severity scenarios. In multivariate analyses, older age was the only characteristic significantly associated with higher time trade-off values. In willingness-to-pay questions, community members offered a mean of $US450 (95% CI 203, 893) to avoid pain of level 3 for 1 month and a mean of $US1384 (95% CI 873, 2050) [year 2005 values] to avoid pain of level 8 for 12 months. Community members traded less money than patients with either shingles or PHN to avoid both low- and high-severity scenarios (p-values <0.05 to <0.001). In multivariate models, male gender, higher income and having experienced shingles or PHN were associated with higher willingness to pay to avoid herpes zoster. When patients were asked to assign a value to avoiding their own case of herpes zoster, those with shingles assigned a mean of 67 days or $US2319, while those with PHN assigned a mean of 206 days or $US18 184. Both the time and monetary value traded were associated with the maximum intensity of the pain the individual had experienced, but neither was associated with the duration of the pain.
We believe that this study provides the most comprehensive information to date on the value individuals place on preventing herpes zoster, and it includes the only such valuation from nationally representative community members as well as patients with herpes zoster. Community members would trade substantial amounts of time or money to avoid herpes zoster, even in the least severe scenarios. The time trade-off results in this study may differ from those in other studies because of important differences in methods of assessing health utilities. Consideration of both community and patient perspectives is crucial to help decision makers fully determine the implications of their policies now that a vaccine against herpes zoster is available.
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ABSTRACT: Objective To assess the knowledge and perception of herpes zoster (HZ) in people with and without contact with HZ cases and to identify factors that could be predictive for vaccination.DesignIn order to assess this knowledge, perception and attitudes to HZ in the general population, the survey design for this study was conducted on the partners of cases and controls included in the study.EmplacementThis study was conducted in general practitioners (GPs) offices within primary healthcare centres.ParticipantsGPs selected patients aged ≥ 55 years with a recent HZ episode, with and without postherpetic neuralgia (PHN) and controls.Methods An epidemiological, cross-sectional, multicentre study was conducted.Results636 questionnaires were completed. More than 75% of persons in all groups were aware of HZ and > 50% considered themselves as susceptible to HZ. Between 66 and 88% of the persons surveyed rated the related pain as important/very important. The interference of the disease with the general activity of patients was considered by 66–78% of the surveyed as moderately important/very important. More than 72% of subjects agreed with the need for a HZ/PHN vaccine. Recommendation by healthcare professional was the most important reason for being vaccinated.ConclusionsHZ and its relationship with pain are known by the general population. Partners of patients with PHN have a higher degree of knowledge of the disease and its consequences and more-frequently consider that a vaccine is needed and are willing to be vaccinated.ResumenObjetivoDeterminar el conocimiento y la percepción de herpes zoster (HZ) en personas con y sin contacto con casos de HZ e identificar los factores que puedan ser predictivos para la vacunación.DiseñoPara la determinación del conocimiento, la percepción y las actitudes de la población general frente a HZ, la investigación en este estudio se llevó a cabo en los familiares de los casos incluidos en él.LocalizaciónEste estudio se llevó a cabo en las consultas de médicos generalistas en centros de asistencia primaria.ParticipantesLos médicos seleccionaron a pacientes de ≥ 55 años con un episodio reciente de HZ, con o sin neuralgia postherpética (NPH) y los controles.MétodosSe realizó un estudio epidemiológico transversal multicéntrico.ResultadosFueron completados 636 cuestionarios. Más del 75% de personas en todos los grupos eran conocedoras de HZ y > 50% se consideraron susceptibles a HZ. Entre el 66 y el 88% de los participantes estimaron el dolor asociado como importante/muy importante. La interferencia de la enfermedad con la actividad general de los pacientes fue considerada por el 66-78% de los participantes como moderadamente importante/muy importante. Más del 72% de los participantes estaban de acuerdo con la necesidad de una vacuna HZ/NPH. Se consideró la recomendación de los profesionales sanitarios como la razón más importante para ser vacunados.ConclusionesHZ y su relación con el dolor son conocidos por la población general. Los familiares de pacientes con NPH tienen un nivel más elevado de conocimiento de la enfermedad y sus consecuencias, consideran con más frecuencia que es necesaria una vacuna y están dispuestos a ser vacunados.Vacunas 07/2011; 12(3):86–94. DOI:10.1016/S1576-9887(11)70012-7
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ABSTRACT: Background As the number of empty-nest elderly rises in the city of Shanghai, ensuring their timely use of health care is a public health concern. The purpose of the study was to examine the home health care needs among the empty-nest elderly living in Shanghai. Methods A questionnaire was administered to 504 empty-nest elderly and 424 non-empty-nest elderly in Shanghai, China. Logistic regression analysis was used to examine the predictors of home health care needs. Linear regression analysis was applied to examine the predictors of willingness to pay for home health care. Results The empty-nest elderly had higher income, less social support, higher prevalence of chronic diseases, were more likely to have worries or concerns about their health and availability of daily care at home or assistance with travel to the doctor's office than the non-empty-nest elderly. They also had higher home health care needs and were willing to pay more money for home health care. Age, education level, social support, and chronic diseases were correlated with home health care needs. Income, social support, and age were associated with willingness to pay for onsite medical services, and income, social support, age, and education level were associated with willingness to pay for social services. Conclusion The empty-nest elderly had more home health care needs due to their having less social support and higher prevalence of chronic diseases, and they were willing to pay more money for the home health care because of the higher income and less social support.International Journal of Gerontology 01/2013; 8(1). DOI:10.1016/j.ijge.2013.01.013 · 0.47 Impact Factor
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ABSTRACT: The burden of illness and healthcare resource utilisation associated with herpes zoster in individuals aged 50 years or above is substantial, causing severe loss of quality of life (QoL). Herpes zoster incidence varies from 1.5 to 5.0 per 1000 person-years in adults of all ages, and reaches 10 cases per 1000 person-years in individuals aged over 60. The most frequent and debilitating complication is post-herpetic neuralgia (PHN). In the absence of antiviral therapy, up to 45% of over 60-year-old experience pain which persists for 6 months to a year. The importance of preventive strategies for PHN is becoming widely recognised. Several systematic reviews confirm that short-term benefit can be gained from antiviral drugs, with limited evidence that they reduce the incidence of PHN. Complementary analgesic drugs are often required. However, prescribing advised medications in old, frail, co-morbid and poly-medicated patients must be carefully considered, as there may be contraindications. Consequently, the difficulties in effectively treating HZ and severe, often intractable PHN that may follow provide a strong argument for the development of effective immunization strategies. In the Shingles Prevention Study, a placebo-controlled trial in adults aged 60 years or more, the HZ vaccine led to a sustained boost of specific cell-mediated immunity with a good tolerance. In older adults, the HZ vaccine has the potential of significantly reducing the HZ burden of illness by decreasing the incidence of HZ or reducing its severity. This review aims to detail and analyse the potential benefits of this immunization.European geriatric medicine 07/2011; 2(3):134-139. DOI:10.1016/j.eurger.2011.06.001 · 0.55 Impact Factor