<p>The Cost-Effectiveness of Universal Varicella Vaccination in Italy: A Model-Based Assessment of Vaccination Strategies</p>

Abstract

Background: In 2017, varicella vaccination became mandatory for all children in Italy, based on a two-dose schedule administered at 12-15 months of age and 5 to 6 years of age. Varicella vaccines are available in different formulations (as a single vaccine or as a combination vaccine together with measles, mumps, and rubella) and are made by multiple manufacturers with different effectiveness profiles. This study calculates the cost-effectiveness of a range of varicella vaccination strategies to identify the optimal strategy for Italy. Methods: A dynamic transmission cost-effectiveness model was applied in Italy to simulate the long-term (50 years) costs and outcomes associated with different varicella vaccination strategies. Five vaccination strategies were evaluated using the model: two doses of two different combination Measles-Mumps-Rubella-Varicella vaccines (either Vaccine A (MSD) [denoted QQVa] or Vaccine B (GSK) [denoted QQVb]); a first dose of a single Varicella vaccine followed by a second dose of a combination vaccine (either Vaccine C (MSD) followed by Vaccine A [denoted MQVa] or Vaccine D (GSK) followed by Vaccine B [denoted MQVb]); or no vaccine at all (NV). The model was adapted for Italy using publicly available Italian data and expert opinion. Results: Over the 50-year time-horizon, in the absence of universal varicella vaccination, there would be 34.8 million varicella cases, 142 varicella-infection-related deaths, and €23 billion in societal costs. The cost per capita from a societal perspective ranged from €164.55 to €392.18 with NV being the most expensive and QQVa the least expensive. The most effective strategy was QQVa, which resulted in a 66% decrease in varicella cases and 30% reduction in varicella-related deaths compared to NV strategy. QQVa led to a net saving in societal cost around €13 billion compared to NV as the cost of vaccination was more than offset by the savings that resulted from the reduced burden of illness. Conclusion: Varicella vaccination has a major impact on reducing varicella incidence, prevalence, and societal costs. This analysis supports the policy for universal varicella vaccination in Italy as the NV strategy was the most expensive and resulted in the poorest outcomes. QQVa offers the greatest benefits at the lowest cost and should be considered as a potential priority strategy for Italian population.

Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

“…These results are consistent with applications of the same dynamic transmission model to other countries [ 13 , 27 , 39 ]. Applied to Turkey, two-dose strategies of universal childhood varicella vaccination were projected to reduce varicella incidence by 99% after 25 years and to be cost-effective [ 13 ].…”

“…The least impactful strategy in terms of cost-effectiveness and resource utilization was strategy D (V-GSK at 15 months and MMRV-GSK at 11 years). These results are consistent with applications of the same dynamic transmission model to other countries [13,27,39]. Applied to Turkey, two-dose strategies of universal childhood varicella vaccination were projected to reduce varicella incidence by 99% after 25 years and to be cost-effective [13].…”

“…Applied to Turkey, two-dose strategies of universal childhood varicella vaccination were projected to reduce varicella incidence by 99% after 25 years and to be cost-effective [ 13 ]. Two-dose vaccination strategies in Italy were projected to reduce varicella cases by 52% to 66% and to be cost saving from both payer and societal perspectives [ 27 ]. Further, universal vaccination with a single vaccine dose in Mexico was projected to be cost saving from the perspective of the national payer system [ 39 ].…”

“…The economic component of the model calculates healthcare usage and costs associated with varicella infection, with costs expressed in NOK (2020 value). The time horizon was 50 years [ 27 ]. Direct costs were computed as costs borne by the healthcare system.…”

Pediatric Hospitalization for Varicella in an Italian Pediatric Hospital: How Much Does It Cost?

“…A transmission cost-effectiveness model applied to simulate the costs and outcomes associated with varicella vaccination strategies showed that over the next 50 years, in the absence of universal varicella vaccination, there would be varicella cases, deaths, and related costs [16]. On the contrary, a vaccination program by the least expensive strategy may lead to a 66% decrease in varicella cases and 30% reduction in varicella-related deaths, with a great saving in societal cost.…”