Imputations for missing data were based on the median distance traveled for the patients with data, stratified by residence (outside or inside Kushiro). medical cost. The mean direct medical and total herpes zoster-related costs per patient were 43, 925 and 57, 112, respectively, and were higher in patients with post-herpetic neuralgia than in those with herpes zoster without complications. Direct medical cost represented 77%, productivity loss 19%, and transportation cost 4% of the total. == Conclusions == This is the first study of the economic burden of herpes zoster and post-herpetic neuralgia in Japan and it demonstrated substantial direct medical cost as a result of the multiple outpatient visits and prescription medications required. These findings provide baseline data for possible future economic evaluations of Montelukast new herpes zoster/post-herpetic neuralgia interventions. == Trial registration == This cost analysis is part of a prospective, physician practice-based cohort study conducted between June 2013 and February 2015 in Kushiro, Japan (Clinicaltrials. gov identifierNCT01873365, registered on 6 June, 2013). == Key Points == == Introduction == Herpes zoster (HZ) occurs when varicella-zoster virus reactivates as a Mouse monoclonal to CD235.TBR2 monoclonal reactes with CD235, Glycophorins A, which is major sialoglycoproteins of the human erythrocyte membrane. Glycophorins A is a transmembrane dimeric complex of 31 kDa with caboxyterminal ends extending into the cytoplasm of red cells. CD235 antigen is expressed on human red blood cells, normoblasts and erythroid precursor cells. It is also found on erythroid leukemias and some megakaryoblastic leukemias. This antobody is useful in studies of human erythroid-lineage cell development result of waning of cell-mediated immunity. The anti-varicella-zoster virus antibody is reported to be prevalent in more than 90% of the Japanese population aged 20 years [1] and is associated with a 30% lifetime risk of developing HZ [2]. Herpes zoster-related pain resolves after approximately 90 days for many patients with HZ, but an estimated 20% will develop post-herpetic neuralgia (PHN) [3], a debilitating long-lasting pain Montelukast that can continue for months or years, requiring long-term analgesic treatment. Annually, about 500, 000 individuals older 60 years develop HZ in Japan [3, 4]. This Montelukast number is expected to increase owing to the aging population with an expected increase in the proportion of people older 60 years from 32% in 2012 to 41% by 2050 [5]. This may potentially increase the economic burden of HZ and PHN on the healthcare system, elderly population, and their caregivers. The economic burden of HZ and PHN has been studied in many countries [612], and these studies demonstrate that both HZ and PHN impose a substantial economic burden on the healthcare system and society. The direct medical cost of managing HZ represents a substantial proportion of the total HZ-related cost, with even higher costs for patients experiencing PHN. Indirect costs owing to sick leave (absenteeism) for patients and caregivers were also considerable [9]. Predictors of higher direct medical costs seemed to be older age, co-morbidities and immunosuppression, duration of hospitalization, use of medications, and the severity of symptoms. Being employed predicted higher indirect costs [13]. To date, no data on health resource utilization and cost owing to HZ in Japan have been published. The objective of this study was to estimate the economic burden of HZ and its complications on the healthcare system and society at large in Japan. == Methods == == Study Design == Cost data were collected as part of an observational, prospective, physician practice-based cohort study of people older 60 years conducted in Kushiro, Japan between June 2013 and February 2015. Four hundred and twelve patients were eligible for the cost analysis. This is the reporting of secondary outcomes for this study that has been previously reported [14]. Study participants were recruited from patients presenting at seven dermatology clinics or hospitals. Herpes zoster was diagnosed by the physician at the initial consultation or at a subsequent visit within 7 days of the initial consultation. The maximum follow-up time for each patient was 270 days from the initial visit. At 90 days after the initial.