The Clinical and Economic Burden of Antibiotic Use in Pediatric Patients With Varicella Infection: A Retrospective Cohort Analysis of Real-World Data in England

Abstract

Background Varicella is a highly infectious disease, particularly affecting children, that can lead to complications requiring antibiotics or hospitalization. Antibiotic use for varicella management is poorly documented. This study assessed antibiotic use for varicella and its complications in a pediatric population in England. Methods Data were drawn from medical records in the Clinical Practice Research Datalink and Hospital Episode Statistics datasets. Patients <18 years old diagnosed with varicella during 2014–2018 with 3-month follow-up available were included. We described varicella-related complications, medication use, healthcare resource utilization, and costs from diagnosis until 3-month post-diagnosis. Results We identified 114,578 children with a primary varicella diagnosis. 7.7% (n = 8,814) had a varicella-related complication, the most common being ear, nose, and throat related (37.1%, n = 3,271). In all, 25.9% (n = 29,706/114,578) were prescribed antibiotics. A higher proportion of patients with complications than those without complications were prescribed antibiotics (64.3%, n = 5,668/8,814 vs. 22.7%, n = 24,038/105,764). Mean annualized varicella-related costs were £2,231,481 for the study cohort. Overall, antibiotic prescriptions cost ∼£262,007. Conclusions This study highlights high antibiotic use and healthcare resource utilization associated with varicella management, particularly in patients with complications. A national varicella vaccination program in England may reduce varicella burden and related complications, medication use, and costs.

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France

“… 38 Conversely, antivirals were amongst the least prescribed medications, prescribed in only 2.2% of varicella cases, which concurred with previous studies in Belgium (2.7%) and England (1.5%). 11 , 37 Over 25% of patients in the study cohort were prescribed antibiotics, which was similar to primary care/outpatient studies of varicella in Belgium (27.3%) and England (25.9%). 11 , 37 Of the 25.1% prescribed an antibiotic in this study, 32.2% of antibiotic prescriptions were associated with a diagnostic code that could be deemed not specific to varicella.…”

“… 11 , 37 Over 25% of patients in the study cohort were prescribed antibiotics, which was similar to primary care/outpatient studies of varicella in Belgium (27.3%) and England (25.9%). 11 , 37 Of the 25.1% prescribed an antibiotic in this study, 32.2% of antibiotic prescriptions were associated with a diagnostic code that could be deemed not specific to varicella. Therefore, it is possible the proportion of varicella patients prescribed antibiotics could be as low as 17%.…”

“…For example, in Belgium, 12.6% of varicella patients in primary care experienced a complication, while in England, 7.7% of patients in primary or secondary care experienced a complication. 11 , 37 …”

“…A recent study in England that used a similar methodology to this study found that while per person medication costs were similar to ours at around €9 (£8.10) per person, GP costs were considerably higher at approximately €102 (£89.50) per person, compared with our estimate of €25.47 per person. 37 This may be due to differences in healthcare systems and methods for deriving costs. The unit costs for GP consultations in this study were derived from conventional tariffs, while the cost for consultations in England took the average annual income of a GP into account.…”