■生殖器疱疹(GH),由1型和2型单纯疱疹病毒(HSV-1,HSV-2)引起,是与不良健康结果相关的常见性传播疾病。与GH爆发相关的症状可以通过抗病毒药物来减少,但是这种感染是无法治愈的,而且是终生的。在这项研究中,我们使用质量调整生命年(QALYs)损失估计了美国GH对健康的长期影响.
■我们使用概率树对18-49岁人群中HSV-1和HSV-2感染继发GH的自然史进行了建模。我们模拟了以下结果,以量化感染后健康损失的主要原因:有症状的疱疹暴发,与诊断和复发相关的社会心理影响,骶骨神经根炎引起的尿潴留,无菌性脑膜炎,Mollaret的脑膜炎,和新生儿疱疹。该模型是根据已发表的有关GH自然历史的文献进行参数化的。我们通过计算每个生殖器HSV-1和HSV-2感染的QALY损失的终生数量来总结健康损失,我们将这些信息与发病率估计相结合,以计算2018年在美国因感染而损失的QALY的总寿命数.
■我们估计在2018年获得的每个事件GH感染损失0.05(95%不确定区间(UI)0.02-0.08)寿命QALY,相当于一个人失去0.05年或约18天的生命健康。由于生殖器HSV-1和HSV-2引起的每次GH感染的平均QALY损失为0.01(95%UI0.01-0.02)和0.05(95%UI0.02-0.09),分别。女性生殖器HSV-1的负担较高,而男性HSV-2的负担较高。每次新生儿疱疹感染的QALY损失估计为7.93(95%UI6.63-9.19)。在人口层面,2018年因GH感染而导致的估计终生QALYs总损失为33,100例(95%UI12,600-67,900),原因为成人GH;3,140例(95%UI2,260-4,140),原因为新生儿疱疹.结果对与诊断后心理社会困扰和症状性复发相关的无效性程度的假设最敏感。
■GH与美国的重大健康损失有关。这项研究的结果可用于比较GH与其他疾病的负担,它提供了可用于研究旨在减少GH负担的干预措施对健康的影响和成本效益的投入。
■疾病控制和预防中心。
UNASSIGNED: Genital herpes (GH), caused by herpes simplex virus type 1 and type 2 (HSV-1, HSV-2), is a common sexually transmitted disease associated with adverse health outcomes. Symptoms associated with GH outbreaks can be reduced by antiviral medications, but the infection is incurable and lifelong. In this
study, we estimate the long-term health impacts of GH in the United States using quality-adjusted life years (QALYs) lost.
UNASSIGNED: We used probability trees to model the natural history of GH secondary to infection with HSV-1 and HSV-2 among people aged 18-49 years. We modelled the following outcomes to quantify the major causes of health losses following infection: symptomatic herpes outbreaks, psychosocial impacts associated with diagnosis and recurrences, urinary retention caused by sacral radiculitis, aseptic meningitis, Mollaret\'s meningitis, and neonatal herpes. The model was parameterized based on published literature on the natural history of GH. We summarized losses of health by computing the lifetime number of QALYs lost per genital HSV-1 and HSV-2 infection, and we combined this information with incidence estimates to compute the total lifetime number of QALYs lost due to infections acquired in 2018 in the United States.
UNASSIGNED: We estimated 0.05 (95% uncertainty interval (UI) 0.02-0.08) lifetime QALYs lost per incident GH infection acquired in 2018, equivalent to losing 0.05 years or about 18 days of life for one person with perfect health. The average number of QALYs lost per GH infection due to genital HSV-1 and HSV-2 was 0.01 (95% UI 0.01-0.02) and 0.05 (95% UI 0.02-0.09), respectively. The burden of genital HSV-1 is higher among women, while the burden of HSV-2 is higher among men. QALYs lost per neonatal herpes infection was estimated to be 7.93 (95% UI 6.63-9.19). At the population level, the total estimated lifetime QALYs lost as a result of GH infections acquired in 2018 was 33,100 (95% UI 12,600-67,900) due to GH in adults and 3,140 (95% UI 2,260-4,140) due to neonatal herpes. Results were most sensitive to assumptions on the magnitude of the disutility associated with post-diagnosis psychosocial distress and symptomatic recurrences.
UNASSIGNED: GH is associated with substantial health losses in the United States. Results from this
study can be used to compare the burden of GH to other diseases, and it provides inputs that may be used in studies on the health impact and cost-effectiveness of interventions that aim to reduce the burden of GH.
UNASSIGNED: The Center for Disease Control and Prevention.