{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T07:12:53Z","timestamp":1769152373520,"version":"3.49.0"},"reference-count":32,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["RP-PG-0108-10048"],"award-info":[{"award-number":["RP-PG-0108-10048"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,27]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and setting<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study participants<\/jats:title>\n                  <jats:p>Data for patients aged \u226516 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>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\u2013utility analysis was performed using the NHS and Social Care perspective.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 49 patients were included; 35 were treated within 48 hours, \u2018early\u2019 (median (IQR) 8.25 [3.7\u201320.5]) and 14 were treated after 48 hours \u2018delayed\u2019 (median (IQR) 93.9 [66.7\u2013100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0\u20133) 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&lt;0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, \u00a323,086 (95% CI: \u00a315,186 to \u00a330,987) vs \u00a342,405 (95% CI: \u00a325,457 to \u00a359,354) [p&lt;0.04]. A -\u00a320,218 (95% CI: -\u00a352,173 to \u00a311,783) cost difference was observed at the 12-\u2009month follow-up post discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-088473","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T06:20:10Z","timestamp":1758262810000},"page":"e088473","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Health economic impact of early versus delayed treatment of herpes simplex virus encephalitis in the UK"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4729-7505","authenticated-orcid":false,"given":"Sylviane","family":"Defres","sequence":"first","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"},{"name":"Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Navvuga","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8610-2806","authenticated-orcid":false,"given":"Shona","family":"Moore","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayley","family":"Hardwick","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ava","family":"Easton","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"Encephalitis International, Malton, North Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedict Daniel","family":"Michael","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Kneen","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"Department of Neurology, Alder Hey Children\u2019s NHS Foundation Trust, Liverpool, Merseyside, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"Department of Neurology, Alder Hey Children\u2019s NHS Foundation Trust, Liverpool, Merseyside, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ENCEPHUK Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonieta","family":"Medina-Lara","sequence":"additional","affiliation":[{"name":"Health Economics Group, University of Exeter Medical School, Exeter, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Solomon","sequence":"additional","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"},{"name":"National Institute for Health Research Health Protection Research Unit in Emerging Zoonotic Infections, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"2025091823200731000_15.9.e088473.1","unstructured":"Davies N . 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