Health Impact and Cost-effectiveness Assessment for the Introduction of Universal Varicella Vaccination in Switzerland

Abstract

Supplemental Digital Content is available in the text. Background: Varicella, caused by the varicella-zoster virus, is a highly contagious infectious disease with substantial health and economic burden to society. Universal varicella vaccination (UVV) is not yet recommended by the Swiss National Immunization Program, which instead recommends catch-up immunization for children, adolescents and adults 11–40 years of age who have no reliable history of varicella or are varicella-zoster virus-IgG seronegative. The objective of this study was to perform an assessment of health impact and cost-effectiveness comparing UVV with current practice and recommendations in Switzerland. Methods: A dynamic transmission model for varicella was adapted to Switzerland comparing 2 base-case schedules (no infant vaccination and 10% coverage with infant vaccination) to 3 different UVV schedules using quadrivalent (varicella vaccine combined with measles-mumps-rubella) and standalone varicella vaccines administered at different ages. Modeled UVV coverage rates were based on current measles-mumps-rubella coverage of approximately 95% (first dose) and 90% (second dose). Direct medical costs and societal perspectives were considered, with cost and outcomes discounted and calculated over a 50-year time horizon. Results: UVV would reduce the number of varicella cases by 88%–90%, hospitalizations by 62%–69% and deaths by 75%–77%. UVV would increase direct medical costs by Swiss Franc (CHF) 39–49 (US $43–54) per capita and costs from a societal perspective by CHF 32–40 (US $35–44). Incremental quality-adjusted life-years per capita increased by 0.0012–0.0014. Incremental cost-effectiveness ratios for the UVV schedules versus the base-case were CHF 31,194–35,403 (US $34,452–39,100) per quality-adjusted life-year from the direct medical cost perspective and CHF 25,245–29,552 (US $27,881–32,638) from the societal perspective. Conclusions: UVV appears highly effective and cost-effective when compared with current clinical practice and recommendations in Switzerland from both a direct medical costs perspective and societal perspective.