Estudio retrospectivo que evalúa la carga de la varicela en México en menores de 1-14 años tratados en 10 sitios

Rivera, Mirella Vázquez; Villarreal, Carlos Pérez Bolde; Monsanto, H; Rampakakis, Emmanouil; Altland, Alexandra; Wolfson, Lara J.

doi:10.18233/apm39no6pp334-3481731

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…An explanation for this difference is that whilst both studies calculated outpatient direct costs mostly from IMSS, 17 for hospitalized direct costs, Graham et al 36 used information from a Mexican panel of experts, while we estimated inpatient costs from real-published data. 16 Our study has several limitations. First, we did not impute the impact of herd immunity induced by vaccination which would have had a positive bias.…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“…Unit costs of varicella in Mexico were obtained from a retrospective study in which net costs of both outpatient and hospitalized varicella cases were analyzed based on the unitary costs by the Mexican Institute of Social Security (IMSS). 16 , 17 The indirect costs were estimated based on the average daily wage in Mexico (2020) of $16.6 USD. 18 In addition, 2.5 and 6.7 days (ie, average hospitalization duration) of caregiver/patient work loss were assumed respectively per outpatient and inpatient case.…”

Section: Methodsmentioning

confidence: 99%

“…18 In addition, 2.5 and 6.7 days (ie, average hospitalization duration) of caregiver/patient work loss were assumed respectively per outpatient and inpatient case. 16 For varicella-related deaths, as the number of days of work lost in any given year could theoretically range from 1 to 365 days, we assumed that 182 days of work were lost because of premature death in an adult case.…”

Section: Methodsmentioning

confidence: 99%

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Economic Evaluation of Universal Varicella Vaccination in Mexico

Chacón-Cruz

Meroc

Clemens

et al. 2021

Pediatric Infectious Disease Journal

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Background: Universal varicella vaccination has proven to be cost-effective (CE) in countries where implemented. However, this has not been evaluated for Mexico. Methods: The yearly disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) was derived from Mexican seroprevalence data adjusted to the 2020 population. The yearly economic burden was calculated by combining disease with Mexican unit cost data from both health care and societal perspectives. Four different vaccination strategies were evaluated: (1) 1 dose of varicella vaccine at 1 year old; (2) 2 doses at 1 and 6 years; (3) 1 dose of varicella vaccine at 1 year, and quadrivalent measlesmumps-rubella-varicella vaccine at 6 years; (4) 2 doses of measles-mumpsrubella-varicella vaccine at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. Vaccination impact (number of avoided cases/deaths) was evaluated for a 20-year follow-up period based on vaccine effectiveness (87% and 97.4% for 1 and 2 doses), and assuming a 95% coverage. We estimated annual costs saved, incremental cost-effectiveness ratio, and costs per life year gained. Results: Avoided cases during the 20-year follow-up with 1, and 2 doses were 20,570,722 and 23,029,751, respectively. Strategies 1 and 2 were found to be cost saving, and strategy 3 to be CE. Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 and $34.41 million USD, respectively, to the Mexican society. Conclusions: Universal varicella vaccination, using 1 dose or 2 doses, would result in a cost-beneficial and CE public health intervention in Mexico.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Economic Evaluation of Universal Varicella Vaccination in Mexico

Chacón-Cruz

Meroc

Clemens

et al. 2021

Pediatric Infectious Disease Journal

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The use of antibiotics in the treatment of pediatric varicella patients: real-world evidence from the multi-country MARVEL study in Latin America & Europe

et al. 2019

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Background Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. Methods Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1–14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. Results Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, β-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. Conclusions High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications. Electronic supplementary material The online version of this article (10.1186/s12889-019-7071-z) contains supplementary material, which is available to authorized users.

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