First Estimates of the Economic Burden and Quality-of-Life Losses Due to Herpes Simplex Virus Type-2 Infections in Low and Middle-Income Countries – a Modeling Study

Background: Economic losses due to herpes simplex infections in low and middle-income countries are unknown. We estimated economic and quality-of-life losses due to genital herpes and HIV-attributable-to-HSV-2 in 2019, in 90 low and middle-income countries, and up to 2030 in 45 countries in the World Health Organization (WHO) Africa region. Methods: For genital herpes, we estimated spending on treatment, losses due to absenteeism and reductions in quality-of-life. For HIV-attributable-to-HSV-2, we estimated spending on ART and losses due to absenteeism. For the WHO Africa region, we modeled costs using an economic model and a deterministic HSV-2 transmission dynamics model, fitted to seroprevalence gathered from a systematic review and meta-regression analysis. Results: Genital herpes contributed to at least US$813.5 million in treatment and productivity losses in 2019 (range: US$674.4-US$952.2 million). Given observed care-seeking and absenteeism, losses are likely in the range of US$29.0 billion (US$25.6 billion-US$34.5 billion). Quality-of-life losses in the amount of 61.7 million QALYs are also possible (50.4 million-74.2 million). The mean annual cost of treatment and wage losses per infection is US$183.00 (95% CI: US$153.60-US$212.55); the mean annual cost of quality-of-life losses is US$343.27 (95% CI: 272.41-414.14). Seroprevalent HSV-2 cases in 2019 also potentially contributed to 33.2 percent of ART costs for incident HIV cases during the year (US$186.3 million; range: US$163.6-US$209.5 million) and 28.6 percent of HIV-related wage losses (US$21.9 million; range: US$19.2–US$27.4 million). In the Africa region, where nearly 40% of ART costs in 2019 are potentially due to HSV-2, the 3.9 million seroprevalent genital herpes cases from 2020 to 2030 can contribute to at least US$700.2 million in treatment and productivity losses. Interpretation: Economic losses of genital herpes are large and disproportionately burden poorer LMICs, especially in sub-Saharan Africa. Quality-of-life losses are even larger. These findings underscore the need for a vaccine against HSV-2. Funding Information: There was no funding source for this study. Declaration of Interests: HHA acknowledges the joint support of Qatar University and Marubeni M-QJRC-2020-5. LJA acknowledges the support of NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation). All other authors have nothing to declare.