Burden of herpes zoster in the UK: findings from the zoster quality of life (ZQOL) study

Abstract

Background: Herpes zoster (HZ) is a painful condition that can have a substantial negative impact on patients' lives. However, UK-specific data on the debilitating impact of HZ, in terms of patients' experience of pain and impairments in Health-Related Quality of Life (HRQoL) are limited. The Zoster Quality of Life (ZQOL) study, a large-scale UK cross-sectional study, was conducted to quantify the burden of HZ in UK patients.

Methods: A total of 229 HZ patients aged 50 years or over were recruited from primary and secondary/tertiary care centres throughout the UK. Patients completed a battery of validated questionnaires, including the Zoster Brief Pain Inventory (ZBPI), the Medical Outcomes Study Short-Form 36 (SF-36) and the EuroQol-5 Dimensions (EQ-5D) on initial presentation to the doctor and again 7-14 days later. At follow-up patients also completed the Treatment Satisfaction with Medication (TSQM) questionnaire. Where available, mean questionnaire scores in the HZ population were compared to scores for age-matched norms to investigate the burden associated with HZ.

Results: Pain was prominent among patients, with 57.9% at the initial study visit reporting pain in the preceding 24 hours at levels typically considered to have a significant impact on HRQoL (i.e. ZBPI worst pain ≥ 5). This was reflected in SF-36 and EQ-5D scores that were significantly lower for patients when compared to age-matched norms (p < 0.05) - except for the SF-36 domain of physical functioning. HRQoL was inversely associated with levels of reported pain, with those patients in the greatest amount of pain reporting the greatest HRQoL impact. However, there was no association between pain severity and participant age. The majority of patients (69.4%) received antivirals within 72 hours of rash appearing and 69.9% of patients were also taking analgesics for the management of HZ pain. TSQM scores indicated that patients were least satisfied with the effectiveness of their prescribed treatment.

Conclusions: The acute presentation of HZ is a painful experience that can have a significant impact on the physical and mental wellbeing of sufferers. Findings highlight significant unmet need among patients, particularly in terms of the effectiveness of therapies for the management of HZ.

Figure 1

Overview of study methodology.

Figure 2

Area of body affected by HZ among ZQOL study patients (n = 229).

Figure 3

ZBPI domain and component scores among HZ ZQOL study patients at initial visit and follow-up. No *s p≥0.05, *p<0.05.

Figure 4

SF-36 domain and component scores among HZ ZQOL study patients at initial visit and follow-up. No *s p≥0.05, *p<0.05; **p<0.01; ***p <0.001. † = clinically meaningful difference. PF=Physical functioning, R-P=Role-physical, BP=Bodily pain, GH=General health, V=Vitality, SF=Social functioning, R-E=Role-emotional, MH=Mental health, PCS=Physical component summary, MCS=Mental component summary.

Figure 5

Per cent of HZ patients reporting any problem on EQ-5D domains at initial visit and follow-up.

Figure 6

TSQM domain scores among HZ study patients, categorized according to prescribed treatment. Note that due to small sample sizes, results for patients receiving no antiviral in combination with level 1 analgesics (n=6) or level 2 analgesics (n=5) have not been presented.