Abstract
Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. Hypothetical cohorts of people aged 12 months and 65-years at baseline. 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. Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). 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. 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.
Highlights
The varicella-zoster virus (VZV) causes both varicella and herpes zoster
Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). It would be cost-effective to vaccinate against varicella, but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY
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
Summary
The varicella-zoster virus (VZV) causes both varicella (chickenpox) and herpes zoster (shingles). Varicella is the clinical presentation of primary infection with the varicella-zoster virus. Due to the high contagiousness of varicella, nearly everyone will contract the disease early in life. A study from 1997 showed that 98% of Swedish 12-year olds had VZV IgG antibodies, i.e. had had varicella at some time point before that age [1]. Varicella is generally a mild disease in children that lasts about a week [2], but complications can occur. Effective vaccines against varicella have been in use since the mid-1990s [3] and routine childhood vaccination programmes are in place in several countries worldwide, for instance, the United States since 1995 and later, Canada, Australia, Germany and Finland [4, 5]. Significant declines in varicella incidence after the introduction of the vaccine have been observed [5,6,7,8]
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