Health-related quality of life with herpes zoster: systematic review and analysis of individual patient data from 9 cohorts

BackgroundHerpes zoster (HZ), or shingles, is a painful rash caused by reactivation of latent varicella zoster virus infection. To better inform health economic evaluation of interventions against HZ, we synthesised evidence from studies measuring the health-related quality of life (HRQoL) of patients with HZ using the EuroQol EQ-5D instrument. MethodsWe systematically reviewed the scientific literature up to 31st October 2024 to identify all studies of HRQoL with HZ from PubMed and Web of Science. We obtained individual-level data from cohorts measuring HRQoL using the EQ-5D. We fit a survival model to the duration of the disutility period, and a mixture distribution to capture changes in HRQoL during the disutility period, to estimate the quality-adjusted life years (QALY) lost due to HZ by age. ResultsWe identified 22 studies reporting a measure of HRQoL with HZ. Of these, 13 studies, covering 16 patient cohorts, measured HRQoL using the EQ-5D tool. We included individual patient data from 9 of these 16 cohorts (1,345 patients) in our quantitative synthesis. We estimated the disutility period for HZ to range between 121 (95% credible interval [CrI]: 112-134) days for 50-year-olds to 193 (163-226) days for 90-year-olds. We estimated the QALY loss due to an HZ episode to range from 0.095 (0.086 - 0.104) at 50 years to 0.146 (0.124 - 0.172) at 90 years of age. ConclusionsThis study is the first to derive a QALY loss estimate for HZ through a systematic review of the literature and analysis of individual patient data. Longer follow-up studies for HZ patients will be important in the future to robustly capture the effect of long-term sequelae and may potentially lead to a higher estimated QALY loss.