Condition

Shingles

Herpes zoster - Viral infection causing painful rash

20M

People Affected

Active Trials

86.7M

New Cases/Year

14K

Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

Valacyclovir

90% Effectiveness• 95% Confidence• 75% Safety• 23 trials• 35K participants

HIGH EvidenceExcellent ValueDose: 1000 mg three times daily for 7 days

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7 days

Response Rate

85%

Remission Rate

75%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

100

Common Side Effects:

Nausea: 18%

Headache: 18%

Vomiting: 8%

Diarrhea: 8%

Annual Cost of Care

Drug Cost

$30

Monitoring

$50

Side Effects

$10

Total Annual

$90

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$25,000/QALY

Cost per Remission

$120

Cost per Responder

$105.88

Treatment Outcomes

Primary Outcomes

Time to Full Rash Crusting24 days

-20.83% (-5 days)

Time to Cessation of New Lesions5.5 days

-27.27% (-1.5 days)

Time to Resolution of Zoster-Associated Pain48 days

-31.25% (-15 days)

Duration of Postherpetic Neuralgia (in affected patients)150 days

-33.33% (-50 days)

Secondary Benefits

Pain Intensity (NRS 0-100)70/100 points

-21.43% (-15 points)

Time to Return to Normal Activities25 days

-28% (-7 days)

Quality of Life (SF-36 PCS score 0-100)38 points

+13.16% (+5 points)

Common Side Effects

Nausea

+18%

Headache

+18%

Vomiting

+8%

Clinical Trial Phases:

Phase 4

Famciclovir

90% Effectiveness• 95% Confidence• 75% Safety• 5 trials• 30K participants

HIGH EvidenceExcellent ValueDose: 500 mg three times daily for 7 days

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7 days

Response Rate

85%

Remission Rate

75%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

100

Common Side Effects:

Headache: 18%

Nausea: 12%

Diarrhea: 8%

Fatigue: 7%

Annual Cost of Care

Drug Cost

$30

Monitoring

$50

Side Effects

$10

Total Annual

$90

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$27,000/QALY

Cost per Remission

$120

Cost per Responder

$105.88

Treatment Outcomes

Primary Outcomes

Duration of Postherpetic Neuralgia (PHN) in patients >50 years60 days

-30% (-18 days)

Time to Full Lesion Healing (Crust Formation)9.5 days

-25% (-2.4 days)

Time to Loss of Zoster-Associated Pain (ZAP)32 days

-19% (-6 days)

Overall Acute Pain Severity (NRS 0-10)Peak daily pain (NRS): 7/10

-20% (-1.4 points)

Secondary Benefits

Duration of Viral Shedding7 days

-45% (-3.15 days)

Impact on Daily Activities (Zoster-Impact Scale 0-100, higher is worse)Zoster-Impact Scale: 70/100

-25% (-17.5 points)

Days Requiring Analgesic Medication25 days

-28% (-7 days)

Common Side Effects

Headache

+18%

Nausea

+12%

Diarrhea

+8%

Clinical Trial Phases:

Phase 4

Acyclovir

85% Effectiveness• 95% Confidence• 75% Safety• 31 trials• 50K participants

HIGH EvidenceExcellent ValueDose: 800 mg five times daily for 7-10 days

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-3 days for symptom improvement

Duration

7-10 days

Response Rate

80%

Remission Rate

70%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

100

Common Side Effects:

Nausea: 12%

Headache: 12%

Vomiting: 8%

Diarrhea: 8%

Annual Cost of Care

Drug Cost

$15

Monitoring

$50

Side Effects

$10

Total Annual

$75

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$15,000/QALY

Cost per Remission

$107.14

Cost per Responder

$93.75

Treatment Outcomes

Primary Outcomes

Time to full crusting of lesions8.5 days

-17.6% (-1.5 days)

Time to resolution of acute pain25 days

-20% (-5 days)

Peak acute pain intensity (NRS)NRS score: 7.5/10

-13.3% (-1 point)

Incidence of Postherpetic Neuralgia (PHN) at 6 months15% risk

-20% (-3 percentage points)

Secondary Benefits

Time to complete healing of all lesions21 days

-14.3% (-3 days)

Duration of analgesic use for acute pain20 days

-25% (-5 days)

Overall reduction in rash severityRash Severity Score: 10 points

-20% (-2 points)

Common Side Effects

Nausea

+12%

Headache

+12%

Vomiting

+8%

Clinical Trial Phases:

Phase 4

Gabapentin

70% Effectiveness• 80% Confidence• 65% Safety• 8 trials• 8K participants

MODERATE EvidenceExcellent ValueDose: 300-3600 mg daily in divided doses

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to weeks for full effect

Duration

Weeks to months

Response Rate

55%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Dizziness: 25%

Somnolence: 22%

Peripheral edema: 8%

Ataxia: 7%

Annual Cost of Care

Drug Cost

$80

Monitoring

$150

Side Effects

$50

Total Annual

$280

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$30,000/QALY

Cost per Responder

$509.09

Treatment Outcomes

Primary Outcomes

Average Daily Pain Intensity7/10 on Numeric Rating Scale (NRS)

-35% (-2.5 points on NRS)

Pain Interference with Sleep6.5/10 on Pain Interference Scale

-25% (-1.6 points on Scale)

Pain Interference with Daily Activities6.5/10 on Pain Interference Scale

-25% (-1.6 points on Scale)

Secondary Benefits

Overall Health-Related Quality of Life55/100 on Visual Analog Scale (VAS)

+13% (+7 points on VAS)

Allodynia/Dysesthesia Severity6/10 on Neuropathic Symptom Scale

-25% (-1.5 points on Scale)

Frequency of Rescue Analgesic Use3 days/week

-50% (-1.5 days/week)

Common Side Effects

Dizziness

+25%

Somnolence

+22%

Peripheral edema

+8%

Clinical Trial Phases:

Phase 4

Pregabalin

70% Effectiveness• 80% Confidence• 65% Safety• 7 trials• 7K participants

MODERATE EvidenceExcellent ValueDose: 75-300 mg twice daily

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

Days to weeks for full effect

Duration

Weeks to months

Response Rate

55%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Dizziness: 30%

Somnolence: 25%

Peripheral edema: 8%

Weight gain: 7%

Annual Cost of Care

Drug Cost

$150

Monitoring

$150

Side Effects

$50

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$35,000/QALY

Cost per Responder

$636.36

Treatment Outcomes

Primary Outcomes

Average Daily Pain Score (NRS)7.0/10 (NRS)

-35.7% (-2.5 points (NRS))

Sleep Interference Score (NRS)6.5/10 (NRS)

-30.8% (-2.0 points (NRS))

Interference with Daily Activities (NRS)6.0/10 (NRS)

-30% (-1.8 points (NRS))

Secondary Benefits

Health-Related Quality of Life (EQ-5D VAS)55/100 (EQ-5D VAS)

+18.2% (+10 points (EQ-5D VAS))

Anxiety Symptoms (HADS-A)12/21 (HADS-A)

-25% (-3 points (HADS-A))

Depression Symptoms (HADS-D)10/21 (HADS-D)

-20% (-2 points (HADS-D))

Common Side Effects

Dizziness

+30%

Somnolence

+25%

Peripheral edema

+8%

Clinical Trial Phases:

Phase 4