Lj Wolfson

Economic burden of varicella in children 1–12 years of age in Argentina, 2009–2014

Abstract Background: In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction. Methods: This was a multi-center, retrospective chart review study among patients aged 1–12 years with a primary varicella diagnosis in 2009–2014 in Argentina. Healthcare resource utilization (HCRU) associated with varicella and its complications, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 United States dollars (USD). Results: One hundred and fifty children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.8 (SD = 2.4) and 2.9 (SD = 2.2) years, respectively. One or more complications were experienced by 28.0% of outpatients and 98.7% of inpatients, the most common being skin and soft tissue infections, pneumonia, sepsis, cerebellitis, and febrile seizure. HCRU estimates included use of over-the-counter (OTC) medications (58.7% outpatients, 94.7% inpatients), prescription medications (26.7% outpatients, 77.3% inpatients), tests/procedures (13.3% outpatients, 70.7% inpatients), and consultation with allied health professionals (1.3% outpatients, 32.0% inpatients). The average duration of hospital stay was 4.9 (95% CI = 4.2–5.7) days, and the average duration of ICU stay was 4.8 (95% CI = 1.6–14.1) days. The total combined direct and indirect cost per varicella case was 2947.7 USD (inpatients) and 322.7 USD (outpatients). The overall annual cost of varicella in Argentina for children aged ≤14 years in 2015 was estimated at 40,054,378.0 USD. Conclusion: The clinical burden of varicella in Argentina was associated with utilization of significant amounts of healthcare resources, resulting in substantial economic costs. These costs should be reduced with the recent implementation of routine vaccination of children.

Understanding the role of exogenous boosting in modeling varicella vaccination

ABSTRACT Introduction: The exogenous boosting (EB) hypothesis posits that cell-mediated immunity is boosted for individuals reexposed to varicella-zoster virus (VZV). Historically, mathematical models of the impact of universal childhood varicella vaccination (UVV) have used limited data to capture EB and often conclude that UVV will temporarily increase herpes zoster (HZ) incidence. Areas covered: We updated a 2013 systematic literature review of 40 studies to summarize new evidence from observational or modeling studies related to EB and its parameterization. We abstracted data on observational study designs and mathematical model structures, EB frameworks, and HZ-related parameter values. Expert commentary: This review identified an additional 41 studies: 22 observational and 19 modeling studies. Observational analyses generally reported pre-UVV increases in HZ incidence, making it difficult to attribute post-UVV increases to UVV versus other causes. Modeling studies considered a range of EB frameworks, from no boosting to full permanent immunity. Mathematical modeling efforts are needed in countries with long-standing vaccination programs to capture the dynamics of VZV transmission and temporal changes that may affect HZ incidence. Use of real-world pre-/postvaccination data on varicella and HZ incidence to validate model predictions may improve approaches to EB parameterization and understanding of the effects of varicella vaccination programs.

Estimating the health and economic impact of universal varicella vaccination in Jordan

Abstract Background To evaluate the impact of adding universal varicella vaccination (UVV) to the existing childhood vaccination programme in Jordan, and identify the most cost-effective strategy. Methods A dynamic transmission model of varicella infection was calibrated to available varicella seroprevalence data within the region and validated against local epidemiological data. Local direct and indirect costs and healthcare utilization data were used. We considered the health and economic impact of one dose UVV administered concurrently with MMR at 12 months of age with 95% coverage, and two dose strategies with short (6 month) and long (4 year) intervals between First and Second dose. We took the societal perspective (direct and indirect costs) and discounted costs and QALYs by 3%/year to assess cost-effectiveness. Results The model estimated the current burden of varicella at 172,000 cases/year, an incidence rate of 2,200/100,000 persons. In the 5th/25th year after vaccination, all strategies substantially reduced total varicella incidence by 89.5%/96.6% (1 dose), 92.3%/98.0% (2 dose short), and 90.5%/98.3% (2 dose long), compared with no vaccine (Figure 1). In the absence of vaccination, an estimated

Economic burden of varicella in children 1–12 Years of age in Hungary, 2011–2015

47.89 M (

The Potential Public Health Impact of Varicella Vaccination in Hungary

28.81 M direct,

The Economic Burden of Varicella in Mexico

19.08 indirect) was spent annually on varicella treatment. The average annual total treatment costs over 25 years from the societal perspective were

Varicella in Poland: economic burden in children 1–12 years of age in Poland, 2010–2015

4.01M (1 dose),

The Cost-Effectiveness of Varicella Vaccination In Peru

3.34M (2 dose short), and

The Economic Burden of Varicella in Peru

3.43M (2 dose long). Considering a willingness to pay (WTP) threshold of

The Implications of Vaccine Characteristics and Private-Sector Vaccination on Varicella; A Model-Based Analysis for Mexico

3,600 USD / QALY and the societal perspective, the 1 dose program was the most cost-effective with cost savings of