Healthcare resource use and costs of varicella and its complications: A systematic literature review

Abstract

Varicella is a highly contagious disease caused by the varicella zoster virus (VZV). While the disease is usually mild, severe complications can occur requiring costly hospitalization. A thorough understanding of the healthcare resource use (HCRU) and costs of varicella is needed to inform health-economic models of preventive strategies. A systematic literature review was carried out to retrieve relevant publications between 1999 and 2021, reporting HCRU and cost outcomes for varicella and its complications. Data were extracted and stratified according to pre-specified age groups and complication categories. Costs were re-based to a $US2020 footing using both purchasing power parity and the medical component of consumer price indexes. Data were summarized descriptively due to high heterogeneity in study design and outcome reporting. Forty-four publications fulfilled the inclusion and exclusion criteria of which 28 were conducted in Europe, 6 in Middle East and Asia, 5 in South America, 3 in North America, and 2 in multiple regions. Primary healthcare visits accounted for 30% to 85% of total direct costs. Hospitalization costs varied between $1,308 and $38,268 per episode depending on country, complication type, and length of stay, contributing between 2% and 60% to total direct costs. Indirect costs, mostly driven by workdays lost, accounted for approximately two-thirds of total costs due to varicella. The management of varicella and related complications can lead to substantial HCRU and costs for patients and the healthcare system. Additional research is needed to further characterize the varicella-associated economic burden and its broader impact from a societal standpoint.

Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study

“…The mean number of varicella-related outpatient visits reported among pediatric patients (1.3 visits) is in line with estimates from the other middle-income countries (1.1 to 2.2 visits per case) and from the literature review of varicella patients of all ages (0.04 to 2.2 visits per case) [ 9 , 19 ]. The mean length of hospital stay of 5.4 days reported for the pediatric population in our study is also consistent with that in the MARVEL study (3.6 to 6.8 days) [ 9 ] but slightly higher than that reported among children in Hong Kong (3.7 days) [ 3 , 32 ].…”

“…A systematic literature review of varicella in the Asia-Pacific region also found the varicella-related average length of hospital stay in the general population (all ages) to range from 3.3 to 7.4 days, which aligns with our results (mean 4.1 days, all ages) [ 3 ]. A recent systematic literature review reported the average length of stay among patients with uncomplicated varicella specifically to range from 2.1 and 4.7 days [ 19 ]. Outpatient visits and hospitalizations not only highlight the direct burden of varicella but also contribute to indirect costs due to potential work loss.…”

“…That medical chart review study found that varicella was associated with substantial HCRU and financial burden on health systems. Systematic literature reviews have found limited data on the economic burden of varicella in the general population in the Asia-Pacific region, with data coming from older studies conducted in high-income countries like Australia, New Zealand, Taiwan, Hong Kong, and Singapore [ 3 , 10 – 19 ].…”