Cost-effectiveness of a routine varicella vaccination program for US children

Abstract

Objective.\p=m-\To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children. Methods.\p=m-\Decisionanalysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database. Results.\p=m-\A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination.However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%.Conclusions.\p=m-\Aroutine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

Epidemiology of varicella zoster virus infection in Canada and the United Kingdom

“…The estimated percent of children with varicella seen by a physician for each year of age for 0-6 years were 57, 48, 32, 21, 22, 27 and 30 %. These estimates fit the reported data for frequency of physician visits for children with chickenpox [25][26][27][28]. Similar estimates for those over 7 years of age were derived from the literature assuming that all individuals contract varicella during their lifetime [1,29].…”

Epidemiology of varicella zoster virus infection in Canada and the United Kingdom – CORRIGENDUM

“…The estimated percent of children with varicella seen by a physician for each year of age for 0-6 years were 57, 48, 32, 21, 22, 27 and 30 %. These estimates fit the reported data for frequency of physician visits for children with chickenpox [25][26][27][28]. Similar estimates for those over 7 years of age were derived from the literature assuming that all individuals contract varicella during their lifetime [1,29].…”

Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

“…For example, the analyst may compare different screening intervals for breast cancer, drug therapies for hypertension, strategies for increasing bicycle helmet use, or approaches to educate the populations at risk for HIV infection. A recent example of a CEA that strongly influenced policy decisions is Lieu et al's analysis of management and treatment strategies related to the new varicella vaccine (40). At the present time, CEA is probably exerting most of its influence in these important yet narrow comparisons of interventions.…”