Background In 2013, Turkey introduced one-dose universal varicella vaccination (UVV) at 12 months of age. Inclusion of a second dose is being considered. Methods We developed a dynamic transmission model to evaluate three vaccination strategies: single dose at 12 months (1D) or second dose at either 18 months (2D-short) or 6 years of age (2D-long). Costs and utilization were age-stratified and separated into inpatient and outpatient costs for varicella and herpes zoster (HZ). We ran the model including and excluding HZ-related costs and impact of exogenous boosting. Results Five years post-introduction of UVV (1D), the projected varicella incidence rate decreases from 1,674 cases pre-vaccine to 80 cases/100,000 person-years. By 25 years, varicella incidence equilibrates at 39, 12, and 16 cases/100,000 person-years for 1D, 2D-short, and 2D-long strategies, respectively, using a highly effective vaccine. With or without including exogenous boosting impact and/or HZ-related costs and health benefits, the 1D strategy is least costly, but 2-dose strategies are cost-effective considering a willingness-to-pay threshold equivalent to the gross domestic product. The model predicted a modest increase in HZ burden during the first 20–30 years, after which time HZ incidence equilibrates at a lower rate than pre-vaccine. Conclusions Our findings support adding a second varicella vaccine dose in Turkey, as doing so is highly cost-effective across a wide range of assumptions regarding the burden associated with varicella and HZ disease.

A number of live-attenuated varicella vaccines are produced globally that provide protection against the varicella zoster virus. In Mexico, varicella vaccination is not included in the national immunization program and is recommended for use only in high-risk subgroups. We developed a budget impact model to estimate the impact of universal childhood immunization against varicella on the national payer system in Mexico. A scenario of no varicella vaccination was compared to scenarios with vaccination with a single dose at 13 months of age, in alignment with the existing program of immunization with the measles-mumps-rubella vaccine. Nine different vaccination scenarios were envisioned, differing by vaccine type and by coverage. Varicella cases and treatment costs of each scenario were computed in a dynamic transmission model of varicella epidemiology, calibrated to the population of Mexico. Unit costs were based on Mexico sources or were from the literature. The results indicated that each of the three vaccine types increased vaccine acquisition and administration expenditures but produced overall cost savings in each of the first 10 years of the program, due to fewer cases and reduced varicella treatment costs. A highly effective vaccine at 95% coverage produced the greatest cost savings.

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BAckground: The National Center for Epidemiology (NCE) provides basic information about the epidemiology of the registered HIV infected patients in Hungary, but there is no evidence about the size or characteristics of the patient population appearing in the healthcare system. Hungary has a comprehensive public health insurance system covering the total population, and Hungarian laws grant public data access. oBjectives: These are the first results from HEARTS: HIV Epidemiology and AntiRetroviral Treatment Study about the prevalence, incidence and mortality of HIV patients requiring healthcare services in the real world setting. Methods: This is a non-interventional retrospective claims database study of patients receiving healthcare services for their HIV infection between 2005-2015 in Hungary. Patients were identified from the National health Insurance Fund Administration (NHIFA) databases based on multiple criteria including International Classification of Diseases and International Classification of Procedures in Medicine codes, and medication purchase data. results: The number of prevalent patients in Hungary increased from 475 in 2005 to 1420 in 2015. The total number of HIV patients in the study period was 1772. Yearly incidence increased from 58 patients in 2005 to 379 in 2015. In the study period, a total of 120 patients died of the 1772 subjects which means a 6.7 % mortality rate. The gender distribution of patients has only changed minimally during the study period: the proportion of male patients has increased slightly, from 2005 (85%) to 2015 (88%). The age group of 30-39 years was the largest for both men and women, and accounted for about 39% of all prevalent patients. conclusions: Less than 60% of the patients registered by the NCE are prevalent in the national healthcare system, and they can appear for care years after their first registration. Anonymised follow-up of these patients can provide valuable information about the treatment patterns and resource use of this population.

BackgroundRoutine childhood immunization with varicella vaccine was first recommended in the United States in 1995 as a 1-dose regimen for children aged 12–18 months, with updated recommendations in 2006 for a 2-dose regimen (first dose at 12–15 months, second dose at 4–6 years). Our objective was to estimate the impact of the US varicella vaccination program.MethodsWe developed a dynamic transmission model to predict the impact on varicella vaccination on health outcomes in the United States. Vaccine coverage rates were extracted from the US National Immunization Survey (NIS); first dose varicella vaccine coverage went from 12% in 1996 to 91% by 2016 for children 18 months old, and second dose coverage starting in 2006 at 5% increasing by 2016 to 94% for children 5 years old; we assumed that 50% of children with no history of vaccination or infection by age 13 would become vaccinated. Interactions between age groups were empirically characterized, and the model was calibrated using age-specific pre-vaccination varicella incidence data.. Vaccine effectiveness was represented via vaccine take and waning immunity estimated from a 10-year trial.ResultsThe model projected reductions of varicella incidence in all ages (and ages <15 years) of 46% (46%) in 2001, 76% (76%) in 2006, 78% (81%) in 2011, and 89% (93%) in 2016 (Figure 1). The projected reductions in varicella cases and varicella-related hospitalizations and deaths for all ages were 74%, 70%, and 66% by 2006 (one-dose era), respectively, increasing to 89%, 70%, and 69% by 2016 (two dose era), respectively (Figure 2). We estimate that between 1996 and 2016, 71,885,382 cases of varicella were prevented in the United States, together with 178,248 varicella-related hospitalizations and 1,496 deaths.ConclusionOur estimates are slightly lower than previously reported US surveillance data which identified a 97.4% (92.9%-97.9%) reduction between 1993–1994 and 2013–2014 in IL, MI, TX, and WV (WER 2016). Likely, this difference is related to under ascertainment of milder cases. This model can be used to estimate the public health benefits of varicella vaccination. The use of a dynamic transmission model does, however, have limitations, including assumptions about age-specific risk and severity of breakthrough disease and the use of a static population. Disclosures L. Wolfson, Merck & Co., Inc.: Employee and Shareholder, Salary. J. Kyle, Merck & Co., Inc.: Independent Contractor, Salary. B. Kuter, Merck: Employee and Shareholder, Salary. M. Levin, Merck Sharp & Dohme Corp.: Scientific Advisor, Consulting fee, Licensing agreement or royalty and Research grant. V. Daniels, Merck & Co., Inc.: Employee and Shareholder, Salary.