The overall economic burden caused by HZ

The overall economic burden caused by HZ includes treatment cost including antiviral and analgesia, consultation fee, hospitalization cost, and indirect cost due to absenteeism from work. The overall costs were highest in the labor productive age group, due to increased significant indirect costs because of absenteeism from work. The indirect costs were highest in the age group 50–59 years (S$ 210.56) followed by the age group 60–69 years (S$63.98; Figure 4).
In general, an individual episode of HZ costs Singapore society S$340, including pharmaceutical treatments, consultation provided by medical professionals, hospitalization, and productivity loss due to the absenteeism from work. It might, therefore, be more costly to treat HZ than the cost of prevention or early diagnoses and treatment. Moreover, patients with PHN incurred 1.92 times more costs than non-PHN patients; this was statistically significant (Table 3).

Discussion
Our study shows that HZ is a debilitating disease causing significant clinical and economic burden to patients in Singapore. PHN led to significantly higher costs with a total cost of S$414.69/patient compared with S$267.26 for a non-PHN patient with HZ. One known HZ study from Singapore in 1997 showed that HZ tended to affect the older age groups and PHN was significantly more common in elderly patients. This study provides updated knowledge related to the burden of herpes zoster in Singapore. Cost analysis including direct and indirect costs was not studied in the previous published paper.
In this study, 84.4% of patients received early antiviral treatment. Early antiviral treatment, preferably within 72 hours of onset, reduces the severity and duration of the acute blistering eruptions. It is therefore important to train general practitioners to recognize the early symptoms and signs of HZ in order for the antivirals to be administered early. Patients should also be educated to identify the prodromal symptoms and skin eruptions related to HZ, and to seek early medical attention.
Our study showed that buy ANA 12 elderly patients were more likely to suffer from pain for >6 months. Approximately 78% of the patients presenting with PHN were aged ≥ 60 years. Previous studies have also indicated that older adults had a significantly higher risk of developing PHN. In light of the growing elderly buy ANA 12 in Singapore (by 2050, approximately 49% of Singaporeans will be aged 65+ years) and increased HZ prevalence increasing with age, the finding of greater severity of illness and longer pain duration in older patients is highly important.
This study had several limitations. Data were collected only from NSC electronic medical records, and not from primary physicians. Additional healthcare costs and days of medical leave may have been obtained from the general practitioner. Estimations of median income and government subsidies were obtained from the Comprehensive Labour Force Survey 2012 and may not be applicable to all patients. The impact of presenteeism or reduced productivity while at work due to discomfort and pain was difficult to quantify, but also represents an increased indirect cost.
The zoster vaccine has been reported to reduce morbidity from HZ and PHN markedly among older patients. The significant clinical and economic burden of HZ indicated in our study underscores the importance of HZ vaccination in high-risk patients, especially for elderly adults who have higher HZ risk and are more likely to suffer from chronic zoster-associated pain.

Acknowledgments

Introduction
Venous ulcer (VU) is a severe clinical manifestation of chronic venous insufficiency. It is responsible for ∼70% of chronic ulcers of the lower limbs, i.e., those that do not heal within 6 weeks.
Studies have shown that an estimated 5–8% of the world population suffer from venous diseases, and approximately 1% develop VUs.
Patients with venous ulceration are often successfully treated with compression dressings, elastic stockings, leg elevation, and topical wound care. The most popular and the most widely used option is compression dressing (bandages), which was introduced by Unna. Several modifications of this technique have been introduced, and the most recent research has shown that the constant pressure application of 20–40 mmHg on the lower extremities yielded the best results in venous ulceration treatment. However, in spite of the compression bandage modality, some venous ulcerations have had unsatisfactory results in regard to this treatment modality. Within a 24-week therapy, the adequate therapy response ranged from 30% to 60% VU, whereas 70–85% were healed during 1 year of VU treatment. Based on clinical experience (in the literature), certain clinical parameters have been defined, especially those that may indicate the prognosis of venous ulceration healing.