Understanding the role of exogenous boosting in modeling varicella vaccination

Talbird, Sandra; La, Elizabeth M.; Mauskopf, Josephine; Altland, Alexandra; Daniels, Vincent; Wolfson, Lara J.

doi:10.1080/14760584.2018.1538801

Cited by 17 publications

(12 citation statements)

References 54 publications

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“…Finally, the appropriate approach to modeling exogenous boosting effects is still being actively debated, and the currently modeled mechanism may not be realistic [5,24]. We have used the temporary full immunity model of exogenous boosting, as have others [20,61].…”

Section: Resultsmentioning

confidence: 99%

“…We have used the temporary full immunity model of exogenous boosting, as have others [20,61]. However, while even the existence of the exogenous boosting effect is still being questioned [69], there is also ongoing research on alternative modeling of the exogenous boosting mechanism [5]. Different modeling approaches have led to very different epidemiologic results.…”

Section: Resultsmentioning

confidence: 99%

“…The proportionality constant may be age dependent; however, in the current study we assume the effect is equal to FOI for all ages. Although there is some evidence that this hypothesis may not be a realistic representation [4,5,20,24,25], it is the base case if exogenous boosting is turned on in the model.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical importance and magnitude of exogenous boosting are not well-characterized, however, and evidence for the effect of UVV on exogenous boosting and the incidence of HZ is inconclusive [4,5]. Reports from the US, where 2-dose UVV has been in place since 2006, suggest that the risk of HZ is reduced among children vaccinated for varicella [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

et al. 2019

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Background In 2013, Turkey introduced one-dose universal varicella vaccination (UVV) at 12 months of age. Inclusion of a second dose is being considered. Methods We developed a dynamic transmission model to evaluate three vaccination strategies: single dose at 12 months (1D) or second dose at either 18 months (2D-short) or 6 years of age (2D-long). Costs and utilization were age-stratified and separated into inpatient and outpatient costs for varicella and herpes zoster (HZ). We ran the model including and excluding HZ-related costs and impact of exogenous boosting. Results Five years post-introduction of UVV (1D), the projected varicella incidence rate decreases from 1,674 cases pre-vaccine to 80 cases/100,000 person-years. By 25 years, varicella incidence equilibrates at 39, 12, and 16 cases/100,000 person-years for 1D, 2D-short, and 2D-long strategies, respectively, using a highly effective vaccine. With or without including exogenous boosting impact and/or HZ-related costs and health benefits, the 1D strategy is least costly, but 2-dose strategies are cost-effective considering a willingness-to-pay threshold equivalent to the gross domestic product. The model predicted a modest increase in HZ burden during the first 20–30 years, after which time HZ incidence equilibrates at a lower rate than pre-vaccine. Conclusions Our findings support adding a second varicella vaccine dose in Turkey, as doing so is highly cost-effective across a wide range of assumptions regarding the burden associated with varicella and HZ disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

et al. 2019

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“…Recent review papers have concluded that although a boosting effect of immunity when exposed to VZV probably exists, the magnitude on a population level is uncertain [13][14][15]. In addition, the experience from countries with long-lasting routine varicella vaccination, such as recent surveillance data from e.g.…”

Section: Plos Onementioning

confidence: 99%

Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model

et al. 2021

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Objectives Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. Design Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. Setting National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. Participants Hypothetical cohorts of people aged 12 months and 65-years at baseline. Interventions Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. Main outcome measures Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). Results It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. Conclusions The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective–the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.

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The necessity for popularizing varicella-zoster virus vaccine programs worldwide: An age-period-cohort analysis for the Global Burden of Disease study 2019

Zhang

et al. 2023

Journal of Infection and Public Health

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Understanding the role of exogenous boosting in modeling varicella vaccination

Cited by 17 publications

References 54 publications

Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model

The necessity for popularizing varicella-zoster virus vaccine programs worldwide: An age-period-cohort analysis for the Global Burden of Disease study 2019

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