TY - JOUR
T1 - Health economic impact of early versus delayed treatment of herpes simplex virus encephalitis in the UK
AU - ENCEPHUK Study Group
AU - Defres, Sylviane
AU - Navvuga, Patricia
AU - Moore, Shona
AU - Hardwick, Hayley
AU - Easton, Ava
AU - Michael, Benedict Daniel
AU - Kneen, Rachel
AU - Griffiths, Michael
AU - Medina-Lara, Antonieta
AU - Solomon, Tom
AU - Backman, Ruth
AU - Baker, Gus
AU - Beeching, Nicholas J.
AU - Breen, Rachel
AU - Brown, David
AU - Cheyne, Chris
AU - Carrol, Enitan D.
AU - Davies, Nicholas W.S.
AU - Eccles, Martin
AU - Foy, Robbie
AU - Garcia-Finana, Marta
AU - Granerod, Julia
AU - Griem, Julia
AU - Gummery, Alison
AU - Harris, Lara
AU - Hickey, Helen
AU - Hill, Helen
AU - Jacoby, Ann
AU - Kierans, Ciara
AU - Kopelman, Michael
AU - Lancaster, Gill
AU - Levin, Michael
AU - McDonald, Rebecca
AU - Menson, Esse
AU - Michael, Benedict
AU - Martin, Natalie
AU - Pennington, Andrew
AU - Pollard, Andrew
AU - Riley, Julie
AU - Sadarangani, Manish
AU - Salter, Anne
AU - Tharmaratnam, Kukatharmini
AU - Thornton, Maria
AU - Vincent, Angela
AU - Warlow, Charles
AU - Barlow, Gavin
AU - Blanchard, Thomas
PY - 2025/9/18
Y1 - 2025/9/18
N2 - Objective Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines. Design and setting A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participants Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measures Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Care perspective. Results A total of 49 patients were included; 35 were treated within 48 hours, € early' (median (IQR) 8.25 [3.7-20.5]) and 14 were treated after 48 hours € delayed' (median (IQR) 93.9 [66.7-100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at the 12- month follow-up post discharge. Conclusions This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.
AB - Objective Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines. Design and setting A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participants Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measures Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Care perspective. Results A total of 49 patients were included; 35 were treated within 48 hours, € early' (median (IQR) 8.25 [3.7-20.5]) and 14 were treated after 48 hours € delayed' (median (IQR) 93.9 [66.7-100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at the 12- month follow-up post discharge. Conclusions This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.
KW - HEALTH ECONOMICS
KW - Infectious disease/HIV
KW - Quality of Life
U2 - 10.1136/bmjopen-2024-088473
DO - 10.1136/bmjopen-2024-088473
M3 - Article
C2 - 40973386
AN - SCOPUS:105016576316
SN - 2044-6055
VL - 15
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e088473
ER -
SDG 3 Good Health and Well-being