Systematic review of economic evaluations of varicella vaccination programmes

Cost-Effectiveness of Varicella Vaccination for 1-4-Year-Olds in Shanghai, China

INTRODUCTION

Varicella has not yet been included in the National Immunization Program (NIP) in China, and varicella vaccination strategies vary by region. To determine the optimal varicella vaccination strategy in Shanghai, China, the cost-effectiveness and 5-year costs of 5 immunization scenarios were analyzed.

METHODS

A static decision tree-Markov model was developed in 2022 to assess the cost-effectiveness and 5-year costs of voluntary and routine varicella vaccination programs in the 2019 birth cohort in Shanghai from a societal perspective. Parameters were collected in 2022 from the varicella surveillance system, a questionnaire survey of 414 guardians of patients with childhood varicella, and semi-structured interviews with 20 experts on varicella outbreaks from different institutions in Shanghai. The outcomes included varicella cases avoided, quality-adjusted life year (QALY) loss, and incremental costs per QALY (ICER). The 5-year costs were compared with local medical expenditures.

RESULTS

Among the 5 scenarios, one dose of routine varicella vaccination was the most cost-saving (USD 70.2) and cost-effective (Dominant) with a 5-year immunization expenditure of USD 9.9 million. Two doses of routine varicella vaccination had the highest QALY (29.9), and its ICER (USD 791.9/QALY) was below the willingness-to-pay threshold (USD 5,203-23,767/QALY). The 5-year immunization expenditure was USD 19.8 million. The effectiveness and price of vaccines, vaccination coverage, and per capita income are the 4 main factors that affect ICERs.

CONCLUSIONS

In Shanghai, the 2 doses of routine varicella vaccination strategy for 1- and 4-year-olds with a 95% coverage rate was found to be the optimal varicella immunization strategy.

An economic evaluation and incremental analysis of the cost effectiveness of three universal childhood varicella vaccination strategies for Ireland

BACKGROUND

The cost effectiveness of childhood varicella vaccination is uncertain, as evidenced by variation in national health policies. Within the European Economic Area (EEA), only 10 of 30 countries offer universally funded childhood varicella vaccination. This study estimates the cost effectiveness of universal childhood varicella vaccination for one EEA country (Ireland), highlighting the difference in cost effectiveness between alternative vaccination strategies.

METHODS

An age-structured dynamic transmission model, simulating varicella zoster virus transmission, was developed to analyse the impact of three vaccination strategies; one-dose at 12 months old, two-dose at 12 and 15 months old (short-interval), and two-dose at 12 months and five years old (long-interval). The analysis adopted an 80-year time horizon and considered payer and societal perspectives. Clinical effectiveness was based on cases of varicella and subsequently herpes zoster and post-herpetic neuralgia avoided, and outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented in 2022 Irish Euro and cost effectiveness was interpreted with reference to a willingness-to-pay threshold of €20,000 per QALY gained.

RESULTS

From the payer perspective, the incremental cost-effectiveness ratio (ICER) for a one-dose strategy, compared with no vaccination, was estimated at €8,712 per QALY gained. The ICER for the next least expensive strategy, two-dose long-interval, compared with one-dose, was estimated at €45,090 per QALY gained. From a societal perspective, all three strategies were cost-saving compared with no vaccination; the two-dose short-interval strategy dominated, yielding the largest cost savings and health benefits. Results were stable across a range of sensitivity and scenario analyses.

CONCLUSION

A one-dose strategy was highly cost effective from the payer perspective, driven by a reduction in hospitalisations. Two-dose strategies were cost saving from the societal perspective. These results should be considered alongside other factors such as acceptability of a new vaccine within the overall childhood immunisation schedule, programme objectives and budget impact.

Burden of chickenpox complications in Poland, 2006 to 2021: A comprehensive registry-based study

BackgroundChickenpox, a vaccine-preventable disease caused by the varicella zoster virus, generally presents with mild symptoms but can cause complications necessitating hospitalisation. In Poland, since 2009, vaccination has been obligatory for children up to 12 years of age who are particularly vulnerable to infection and for children in their vicinity.AimTo examine the burden of chickenpox complications and the trends of hospitalisation arising from these complications over time in the Polish population.MethodsData spanning 2006-21 were sourced from the Polish Infectious Diseases Surveillance System, the Nationwide General Hospital Morbidity Study and the Statistics Poland death registry. Standardised and age-specific incidence rates, hospital discharge rates and number of deaths because of chickenpox were calculated. Moreover, the joinpoint regression model was used to analyse trends of annual hospital discharge rates.ResultsOver the analysed timeframe, 25,804 hospitalisations and 52 deaths attributable to chickenpox complications were documented, and 1.0% of chickenpox cases required hospitalisation because of chickenpox. Age-standardised hospitalisation rates varied between 2.3 and 9.6 per 100,000 population. The analysis revealed no statistically significant trend in overall hospital discharge rates from chickenpox complications. However, a notable increase in hospitalisation rates was observed in children aged 0-4 and among inhabitants of rural areas, with annual percentage changes of 4.9% and 3.4% respectively.ConclusionsOur findings suggest that the implementation of a universal chickenpox immunisation programme, supported by health education, should be considered to reduce the number of hospitalisations and nearly eliminate deaths because of chickenpox.

Economic evaluation of second measles containing vaccine (MCV) dose: a systematic review of available evidence

INTRODUCTION

The global measles incidence has decreased from 145 to 49 cases per 1 million population from 2000 to 2018, but evaluating the economic benefits of a second measles-containing vaccine (MCV2) is crucial. This study reviewed the evidence and quality of economic evaluation studies to guide MCV2 introduction.

METHODS

The systematic review of model-based economic evaluation studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 2231 articles, with 876 duplicates removed and 1355 articles screened, with nine studies included for final analysis.

RESULTS

Six studies reported a positive benefit-cost ratio with one resulting in net savings of $11.6 billion, and two studies estimated a 2-dose MMR vaccination program would save $119.24 to prevent one measles case, and a second dose could prevent 9,200 cases at 18 months, saving $548.19 per case. The most sensitive variables were the discount rate and vaccination administration cost.

CONCLUSIONS

Two MCV doses or a second opportunity with an additional dose of MCV were highly cost-beneficial and resulted in substantial cost savings compared to a single routine vaccine. But further research using high-quality model-based health economic evaluation studies of MCV2 should be made available to decision-makers.

PROSPERO REGISTRATION

CRD42020200669.