Economic burden of varicella in children 1–12 Years of age in Hungary, 2011–2015

Abstract

BackgroundAlthough live-attenuated varicella-zoster virus (VZV) vaccines have been proven to be safe and effective in preventing varicella and real-word evidence shows routine childhood immunization programs are effective in dramatically reducing varicella associated morbidity and mortality, varicella vaccine is not included in the National Immunization Program (NIP) in Hungary. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Hungary.MethodsThis was a multicenter, retrospective, chart review study of patients aged 1–12 years with a primary varicella diagnosis between 2011 and 2015. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 HUF / Euros (€).Results156 children with varicella were included (75 outpatients, 81 inpatients), with a mean age of 4.4 (SD: 2.0) and 3.7 (SD: 2.1) years, respectively. One or more complications were reported by 12.0% of outpatients and 92.6% of inpatients, the most common being dehydration, skin and soft tissue infections, pneumonia, keratoconjunctivitis, and cerebellitis. HCRU estimates included use of over-the-counter (OTC) medications (96.0% outpatients, 53.1% inpatients), prescription medications (9.3% outpatients, 70.4% inpatients), tests/procedures (4.0% outpatients, 97.5% inpatients), and consultation with allied health professionals (2.7% outpatients, 30.9% inpatients). The average duration of hospital stay (inpatients) was 3.6 (95% CI: 3.2, 4.1) days. The total combined direct and indirect cost per varicella case was 228,146.7 Hungarian Forint (HUF)/€ 736.0 for inpatients and 49,790.6 HUF/€ 106.6 for outpatients. The overall annual cost of varicella in Hungary for children aged <15 years in 2015 was estimated at 1,903,332,524.3 HUF/ € 6,139,980.4.ConclusionVaricella is associated with substantial clinical burden in Hungary, resulting in the utilization of a significant amount of healthcare resources. These results support the need for routine vaccination of all healthy children to reduce the varicella-associated disease burden.

Burden of varicella in Central and Eastern Europe: findings from a systematic literature review

“…Reliable information on primary care visits for varicella is not available in all CEE countries. However, data from Hungary for the period 2011-2015 reveal a substantial disease burden related to varicella among children, with 87% of outpatients visiting their doctor at least once and 20% visiting a hospital outpatient clinic [3].…”

“…While varicella is usually a mild or moderate illness [1][2][3][4], a small proportion of varicella cases are serious, including complications such as superinfection of the skin or soft tissue, respiratory syndromes, and neurological manifestations (e.g. cerebellar ataxia, encephalitis) [1,5].…”

Modeling the transmission dynamics of varicella in Hungary

“…Cost-benefit calculations. In 2017, [10] gave a comprehensive study on the economic burden of varicella in Hungary using descriptive statistical methods. There are many uncertainties related to the introduction of VZV-vaccination.…”

“…[1,3,4,11]. However, there are hardly any stud-ies about Hungary ( [10] is a retrospective, descriptive study), where the introduction of varicella vaccination into the routine childhood vaccination program is being introduced. Given the actuality and the importance of this issue, here we summarize the challenges of such a modeling work, draw some conclusions from the qualitative and experimental study of simple compartmental models and devise a plan for comprehensive future work.…”

The clinical and economic burden of varicella in the Middle East: a systematic literature review

“…Recent studies report a significant clinical, resource, and economic burden associated with varicella in countries where UVV programs have not been implemented, such as Poland, Argentina, and Hungary. [73][74][75] Occurrence of complications and the need for hospitalizations placed demand on health-care resources (e.g., need for medications, tests/diagnoses, health-professional consultations) as well as having an indirect economic impact (e.g., time taken off work to look after children). [73][74][75] Although data on the impact of varicella vaccination in the Middle East are limited, the data that are available indicate that the UVV has the potential to substantially reduce the clinical burden of the disease.…”