Program Costs Research Articles

Retrospective evaluation of implementation of caring contacts for youth suicide prevention in an emergency department.

Caring Contacts are brief caring messages sent to patients with suicidal thoughts or behaviors after an emergency department (ED) visit or hospitalization, which may decrease subsequent suicide attempts. We aimed to retrospectively evaluate the implementation of Caring Contacts in a children's hospital ED. We conducted a retrospective observational study to evaluate the implementation of Caring Contacts within routine clinical care at an academic children's hospital ED from May 2020 to April 2023. Patients 5‒18 years old presenting for suicidal thoughts or behaviors were eligible to receive six handwritten cards with individualized caring messages, mailed over 12 months. We assessed enrollment rates (the percentage of patients offered Caring Contacts who agreed to receive them), fidelity to the intended schedule and card writer, return visits for suicidal ideation or behaviors while receiving Caring Contacts, and program costs. Of 627 encounters eligible for and offered Caring Contacts, 614 (98%) resulted in enrollment. Among instances of enrollment, 587 (96%) had cards sent per the intended schedule and 541 (88%) had cards written by the intended writer. A return ED visit for suicidal ideation or behaviors occurred for 168 (27%) during program participation. Costs per participant were $4.54 in materials and 0.9h of personnel time. In a children's hospital ED, Caring Contacts were feasible to implement with low costs and high fidelity to the intended schedule and card writer. Prospective studies are needed to assess Caring Contacts' effectiveness in reducing suicide risk among adolescents following an ED visit.

Cost effectiveness of a vascular access education and training program for hospitalized emergency department patients.

Education and training in vascular access is a critical component to delivering quality vascular access care. Given that organizations must invest resources to implement and sustain high-quality vascular access programming, we aimed to demonstrate the cost effectiveness of a program (Operation STICK (OSTICK)) in the emergency department (ED). This was an observational cohort study conducted at a tertiary care academic center with 120,000 ED visits. Consecutive hospitalized adults with ultrasound-guided (DIVA) and traditionally-placed (non-DIVA) peripheral intravenous catheters (PIVC) in the ED were included in the analysis. Two groups (OSTICK and non-OSTICK) were compared in the analysis: OSTICK PIVCs were inserted by clinicians with formal, standardized training in peripheral venous access while non-OSTICK PIVCs were inserted by staff with basic departmental training in PIVC care. Cost factors included number of procedures, wait time to establish a PIVC, complications, and training. Effect was complication-free PIVC functionality. Multiple linear regressions were used to estimate incremental cost (ΔC), incremental effect (ΔE), and incremental net benefit (INB) of the OSTICK program. From 10/1/2022 thru 3/31/2023, 21,259 PIVCs including 1681 OSTICK and 19,578 non-OSTICK PIVCs were included in the analysis. Average age was 64.8 and 53.7% were female. The estimate of incremental cost (ΔC) for each patient was -$83.175 (95% CI: -$103.953 to -$62.398; p<0.001), indicating that the OSTICK group saves money compared to the non-OSTICK group. The OSTICK group is also more effective at increasing the proportion of catheter dwell time relative to hospital length of stay (ΔE), with an estimate of 0.037 (95% CI: 0.016 to 0.059; p<0.001), compared to those in the non-OSTICK group. The estimated incremental cost-effectiveness ratio (ICER) for the OSTICK group compared with the non-OSTICK group was -$221.964 (95% CI: -$177.400 to -$381.716) per ten percentage points of PIVC dwell time to hospital length of stay increase. Strategic investment in vascular access education and training can yield impressive financial returns while simultaneously enhancing vascular access outcomes. It is imperative for organizations to recognize the significant impact of such initiatives and prioritize the implementation of comprehensive programs.

Training in Transplantation and Cellular Therapy in Latin America: A Cross-Sectional Study of the LABMT

Hematopoietic cell transplantation (HCT) is a complex and resource-intensive procedure that has become a critical treatment for certain hematologic conditions. However, in Latin America, access to HCT is limited compared to high-income countries, in part due to a lack of standardized training programs for HCT professionals. To address this gap, the Latin-American Bone Marrow Transplantation Group conducted a cross-sectional study to assess the current state of training programs in HCT and cellular therapy across the region. This study aimed to describe and analyze the availability, characteristics, and challenges of HCT training programs in Latin America, with a focus on identifying barriers and proposing solutions for improvement. A cross-sectional survey was sent to 127 recognized HCT centers across 14 Latin-American countries in December 2022. The survey collected data on institutional characteristics, training program structure, costs, and barriers to program development. Descriptive statistics were used to summarize the data, and comparative analyses were performed using Chi-square and Mann-Whitney tests. Of the 127 centers surveyed, 50 (39%) responded, with the majority located in Brazil (34%) and Mexico (30%). Among the respondents, 64% (n = 32) offered formal training programs lasting 6 months or longer. The most significant barriers reported were lack of funding (n = 21), limited number of transplant procedures (n = 15), and a shortage of qualified professors (n = 11). Proposed solutions included increasing student mobility opportunities (n = 28), enhancing program quality (n = 27), and improving access to funding (n = 15). Only 6% of programs offered exposure to CAR-T therapy, and fewer than half of the centers provided international rotations. This study highlights significant disparities in HCT training programs across Latin America, with most countries lacking access to formalized training. While Brazil and Mexico serve as regional hubs, other nations have limited or no training opportunities. Addressing these gaps through increased funding, international collaborations, and standardized curricula is essential to improving HCT training and ultimately patient care in the region.

Economic Analysis of National Program for Hepatitis C Elimination, Israel, 20231.

In 2021, the Israel Ministry of Health began a national hepatitis C elimination program. Implementing a World Health Organization goal, Israel's program involved targeted screening, barrier minimization, workup simplification, awareness campaigns, and a patient registry. We evaluated program costs for testing and treatment. By May 15, 2023, the program had identified 865,382 at-risk persons, of whom 555,083 (64.3%) were serologically screened for hepatitis C virus (HCV), which was detected in 24,361 (4.4%). Among 20,928 serologically positive patients, viremia was detected in 13,379 (63.9%), of whom 10,711 (80%) were treated, and 4,618 (96.5%) of 4,786 persons receiving posttreatment HCV RNA testing had sustained virologic response. We estimated costs of ₪14,426 (new Israel shekel; ≈$3,606 USD) per person whose HCV infection was diagnosed and successfully treated. The program yielded screening and treatment in almost two thirds of the identified at-risk population. Although not eliminated, HCV prevalence will likely decrease substantially by the 2030 target.

Healthy Communities for Youth: A Cost Analysis of a Community-Level Program to Prevent Youth Violence

Youth violence is a national public health concern in USA, especially in resource-constrained urban communities. Between 2018 and 2021, the Healthy Communities for Youth (HCFY) program addressed youth violence prevention in select economically marginalized urban communities, with the HCFY program reducing the likelihood of youth-involved violent crime. Leveraging costs from program expense reports, this study analyzes the costs of the HCFY program in order to inform policymaking and the program’s future ongoing implementation. Total HCFY program costs were $821,000 ($290,100 annually including program start-up costs) over the 34-month project period. Operationalization costs contributed the largest share (64.8%), with 45% attributable to intervention coordinators. In the intervention community, the program costs $100 per capita, $1100 per youth-involved crime case, and $8100 per youth-involved violent crime case. Findings were sensitive to the number of youth-involved crime or violent crime cases and costs of high-level program leadership and self-evaluation analysts, with the per youth-involved violent crime case cost ranging between $700 and $1600 over the program period. Analysis of HCFY program costs is an important step in determining the affordability of a community-level program to prevent youth violence in resource-limited urban communities.

Economic evaluation of acupuncture in treating patients with pain and mental health concerns: the results of the Alberta Complementary Health Integration Project.

The COVID-19 pandemic and its economic impact have heightened the risk of mental health and pain-related issues. The integration of acupuncture with conventional medicine shows promise in improving treatment outcomes for these conditions. The Alberta Complementary Health Integration Project (ABCHIP) aimed to provide acupuncture to youth (aged 24 and under) and seniors (aged 55 and above) experiencing chronic pain, pain management issues, mental health issues, and/or related conditions. The program aimed to promote integrative care, assess the effectiveness and cost-effectiveness of these therapies, and deliver patient-centered care. ABCHIP provided acupuncture to address pain, mental health, and addiction issues at no cost to two vulnerable populations in Alberta: youth and the older adult. A total of 606 patients aged 14-65 received 5,424 acupuncture treatments. Outcome measures included pain interference, pain severity, sleep quality, depression, anxiety, fatigue, anger, and quality of life. Short-term outcomes were assessed through questionnaires completed at the beginning and completion of the treatments, while long-term benefits were estimated using these outcome indicators and existing literature on the economic cost of illnesses. The cost-effectiveness analysis revealed the following ratios per Quality-Adjusted Life Year (QALY): CND12,171 for the overall sample, CND10,766 for patients with pain, CND9,331 for individuals with depression, and CND9,030 for those with anxiety. The cost-benefit analysis demonstrated annual cost savings ranging from CND1,487 to CND5,255, with an average of CND3,371. The study findings indicate that ABCHIP's treatment for pain, depression, anxiety, and sleep issues is cost-effective, leading to substantial cost savings and improved quality of life for patients. The program's cost per Quality-Adjusted Life Year (QALY) is significantly lower than benchmarks used in other countries, demonstrating high cost-effectiveness and value. Patients receiving 12 treatments experienced significant improvements across all measures, with estimated economic benefits surpassing treatment costs. In summary, ABCHIP offers a cost-effective and economically efficient therapy choice for individuals dealing with pain and mental health issues.

Which stakeholders should be addressed to promote Geriatric Medicine among healthcare professionals, educationalists and policy-makers in European countries? – the PROGRAMMING COST 21,122 action experience

BackgroundGeriatric Medicine (GM), concerned with well-being and health of older adults, can play a crucial role in the alignment of healthcare systems to the needs of the aged populations. However, countries have varying GM development backgrounds. The goal of PROGRAMMING- COST 21,122 Action is to propose the content of education and training activities in GM for healthcare professionals across various clinical settings, adapted to local context, needs, and assets. Defining relevant stakeholders and addressing them on both an international as well as a country-specific level is crucial for this purpose. In this paper we are describing the methods used in the PROGRAMMING Action 21,122 to map the different categories of stakeholders to be engaged in the Action.MethodsThrough conceptualizing a model for stakeholders by literature research, and online discussion group meetings, a synthesis for the potential stakeholders was defined as a template, and pilot applications were requested from participant countries.ResultsThere were 24 members from 14 countries (6 males/18 females) of multidisciplinary professions involved in this study. A model for the list of stakeholders to be addressed was developed and, after seven online discussion meetings, a consensus framework was provided. Invited countries completed the templates to pilot such operationalization.ConclusionOur framework of stakeholders will support the research coordination and capacity-building objectives of PROGRAMMING, including the participation into the assessment of educational needs of healthcare professionals. Identified stakeholders will also be mobilized for purposes of dissemination and maximization of the Action’s impact. By defining and mapping multidisciplinary stakeholders involved in older people’s care specific to countries, particularly where GM is still emerging, GM tailored educational activities will be facilitated and optimally targeted.

Static Scheduling of Weight Programming for DNN Acceleration with Resource Constrained PIM

Most existing architectural studies on ReRAM-based processing-in-memory (PIM) DNN accelerators assume that all weights of the DNN can be mapped to the crossbar at once. However, these studies are over-idealized. ReRAM crossbar resources for calculation are limited because of technological limitations, so multiple weight mapping procedures are required during the inference process. In this article, we propose a static scheduling framework which generates the mapping between DNN weights and ReRAM cells with minimum runtime weight programming cost. We first build a ReRAM crossbar programming latency model by simultaneously considering the DNN weight patterns, ReRAM programming operations, and PIM architecture characteristics. Then, the model is used in the searching process to obtain an optimized weight-to-OU mapping table with minimum online programming latency. Finally, an OU scheduler is used to coordinate the activation sequences of OUs in the crossbars to perform the inference computation correctly. Evaluation results show the proposed framework significantly reduces the weight programming overhead and the overall inference latency for various DNN models with different input datasets.

57 Nature based social prescribing for enhancing mental health and well-being

Abstract Objectives Nature Based Social Prescribing (NBSP) is a means of connecting people with non-clinical, nature-based community-led interventions delivered by 3rd sector organisations using local community assets. This research used a mixed-method Social Return on Investment (SROI) of a six-month pilot ‘Making Well’ NBSP programme to support individuals with chronic mental health conditions in Wales. Methods The ‘Making Well’ programme costs were estimated by means of SROI along projected 20% overheads, were incorporated to reflect sustainable costs as the charity develops and more accurately estimate the future social value expected to be generated. The ‘Making Well’ project delivered two separate programmes between October 2021 and April 2022. Data was collected from participants (n = 12) at baseline and eight-week follow-up along with interviews to collect in-depth data on individuals lived experience of participating in the programme. The ‘Making Well’ programme costs were estimated and financial proxies from the HACT Social Value (SV) bank were applied to identified benefits. Results The estimated cost of ‘Making Well’ programme inputs were £1,312 per participant and the net value of well-being benefits were £4,313 to £6,130 per participant, giving a range of SVR’s between £3.30 to £4.70 for every £1 invested in this NBSP intervention. The SROI forecast provides a three-year projection of the annual social value created and the estimated forecast cost of programme inputs was £797 per participant. The net value of well-being benefits was £4,313 to £6,130 per participant, giving a range of social value ratios between £5.40 to £7.70 for every £1 invested. Conclusions The SROI results demonstrate that the ‘Making Well’ programme is an effective NBSP intervention for supporting people with enduring mild to moderate mental health conditions. This SROI contributes to emerging evidence on the use of community assets and NBSP in generating a return on investment and positive social value. SROI forecasting for socially prescribed interventions delivered by local community assets, such as The Fathom Trust, can help organisations demonstrate transparent and effective investment of public funds and support optimal future social value creation and long-term public health outcomes.

Evaluating the Impact of a Clinical Breast Examination Screening Program within the IraPEN Project.

Breast cancer is a prevalent global cancer and a leading cause of mortality in developed countries. In 2015, Iran introduced the Package of Essential Noncommunicable Diseases (IraPEN) as a pilot project to tackle prevalent noncommunicable diseases, including breast cancer. However, there is limited research evaluating the implementation, costs, and outcomes of breast cancer screening within IraPEN. Therefore, this study aims to investigate the costs and outcomes of the clinical breast examination screening program in Isfahan from 2017 to 2020. This descriptive cost-outcome study utilized data from 450,876 individuals aged 30 to 69 who participated in clinical breast examination screening. The outcomes assessed in this program encompassed the number of participants, the number of individuals identified with symptoms, referrals to the next level of examination, the number of individuals undergoing mammography, recorded mammography results, and the number of cases of breast cancer identified. Direct costs were estimated, including personnel, infrastructure, equipment, and other related expenses. ‌The findings revealed that the direct costs of the breast cancer screening program in Isfahan between 2017 and 2020 were 310,514,608,558 Rials, equivalent to approximately 15,470,633 PPP$. These expenses led to the identification of 134,508 individuals with symptoms, referrals of 258,599 individuals to the subsequent level of examination, and approximately 55,974 individuals undergoing mammography tests. This study demonstrates that the breast cancer screening program provides a significant number of women in the target age group with breast self-examination education while raising public awareness about this disease.

Using Design-Based Research to Develop the Learning Outcomes of a Curriculum-Based Environmental Citizen Science Project

The Intertidal Monitoring Project (IMP) is a local, curriculum-based citizen science project intentionally designed to support the development of science competencies in elementary students. The focus of the IMP is the Research Days, where students follow an established scientific protocol to collect monitoring data on an introduced species of clam in British Columbia, Canada. The IMP represents a unique program to study because the school district funds transportation and programming costs so that all grade five students can engage in authentic place-based scientific research. A design-based research (DBR) approach was used to develop and refine the IMP activities between 2014 and 2023. This research is focused on a DBR Evaluation/Reflection phase that qualitatively assessed learning outcomes during the beta testing of a supplementary classroom activity. Student- and teacher-generated data were collected to understand the process of a class “coming to know” science and its community of practice during the IMP activities. This included student learning artefacts and a teacher interview. The findings show that participation in IMP activities: i) fostered the development of science competencies in a grade five learning community; ii) did not promote science identities; and indicated that iii) the Nature of Science (NOS) required more explicit instruction. Student-teacher-scientist partnerships (STSPs) emerged as a critical design element of curriculum-based citizen science.

Climate neutrality of the French energy system: overview and impacts of sustainable aviation fuel production

CO2 emission reduction of sectors such as aviation, maritime shipping, road haulage, and chemical production is challenging but necessary. Although these sectors will most likely continue to rely on carbonaceous energy carriers, they are expected to gradually shift away from fossil fuels. In order to do so, the prominent option is to utilize alternative carbon sources—like biomass and CO2 originating from carbon capture—for the production of non-fossil carbonaceous vectors (biofuels and e-fuels). However, the limited availability of biomass and the varying nature of other carbon sources necessitate a comprehensive evaluation of trade-offs between potential carbon uses and existing sources. Then, it is primordial to understand the origin of carbon used in sustainable aviation fuel (SAF) to understand the implications of defossilizing aviation for the energy system. Moreover, the production of SAF implies deep changes to the energy system that are quantified in this work. This study utilizes the linear programming cost optimization tool EnergyScope TD to analyze the holistic French energy system, encompassing transport, industry, electricity, and heat sectors while ensuring net greenhouse gas neutrality. A novel method to model and quantify carbon flows within the system is introduced, enabling a comprehensive assessment of greenhouse gas neutrality. This study highlights the significance of fulfilling clean energy requirements and implementing carbon dioxide removal measures as crucial steps toward achieving climate neutrality. Indeed, to reach climate neutrality, a production of 1,046 TWh of electricity by non-fossil sources is needed. Furthermore, the findings underscore the critical role of efficient carbon and energy valorization from biomass, providing evidence that producing fuels by combining biomass and hydrogen is optimal. The study also offers valuable insights into the future cost and impact of SAF production for air travel originating from France. That is, the European law ReFuelEU would increase the price of plane tickets by +33% and would require 126 TWh of hydrogen and 50 TWh of biomass to produce the necessary 91 TWh of jet fuel. Finally, the implications of the assumption behind the production of SAF are discussed.

Optimizing the cost of the STEP programme.

The Spherical Tokamak for Energy Production (STEP) programme is a world-leading fusion power plant programme that has embedded a cost conscience in its design from the early phases. This firmly addresses the attitude of cost complacency of which many major infrastructure projects have historically been accused. While a detailed and highly accurate whole life cycle cost analysis is not possible, or even valuable, during the conceptual design stage, this early design phase is still the most critical programme phase where a focus on costs can drive longer term reductions and impact whole life cycle costs at the high level. Consequently, appropriate estimating methods for these early-stage designs and lessons learned from other industries are used to inform design decisions and ensure cost is part of the overall option analysis. Hence, while the overall programme cost estimate is too immature to be a reliable indicator for the final programme costs, significant effort has been undertaken to understand the major cost drivers and take action to make the STEP design as cost-effective as possible. This article is part of the theme issue 'Delivering Fusion Energy - The Spherical Tokamak for Energy Production (STEP)'.

Story of Your Lazy Function’s Life: A Bidirectional Demand Semantics for Mechanized Cost Analysis of Lazy Programs

Lazy evaluation is a powerful tool that enables better compositionality and potentially better performance in functional programming, but it is challenging to analyze its computation cost. Existing works either require manually annotating sharing, or rely on separation logic to reason about heaps of mutable cells. In this paper, we propose a bidirectional demand semantics that allows for extrinsic reasoning about the computation cost of lazy programs without relying on special program logics. To show the effectiveness of our approach, we apply the demand semantics to a variety of case studies including insertion sort, selection sort, Okasaki's banker's queue, and the implicit queue. We formally prove that the banker's queue and the implicit queue are both amortized and persistent using the Rocq Prover (formerly known as Coq). We also propose the reverse physicist's method, a novel variant of the classical physicist's method, which enables mechanized, modular and compositional reasoning about amortization and persistence with the demand semantics.

Protocol for the Australian Type 1 Diabetes National Screening Pilot: Assessing the feasibility and acceptability of three general population screening models in children.

One third of Australian children diagnosed with type 1 diabetes present with life-threatening diabetic ketoacidosis (DKA) at diagnosis. Screening for early-stage, presymptomatic type 1 diabetes, with ongoing follow-up, can substantially reduce this risk (<5% risk). Several screening models are being trialled internationally, without consensus on the optimal approach. This pilot study aims to assess three models for a routine, population-wide screening programme in Australia. An implementation science-guided pilot study to evaluate the feasibility, acceptability and costs of three screening models in children will be conducted between July 2022 and June 2024. These models are as follows: (1) Genetic risk-stratified screening using newborn heel prick dried bloodspots, followed by autoantibody testing from 11 months of age; (2) genetic risk-stratified screening of infant (6-12 months) saliva followed by autoantibody testing from 10 months of age; and (3) autoantibody screening using capillary dried bloodspots collected from children aged 2, 6 or 10 years. Cohorts for each model will be recruited from targeted geographic areas across Australia involving ≥2 states per cohort, with a recruitment target of up to 3000 children per cohort (total up to 9000 children). The primary outcome is screening uptake for each cohort. Secondary outcomes include programme feasibility, costs, parental anxiety, risk perception, satisfaction, well-being and quality of life, and health professional attitudes and satisfaction. This pilot is the first direct comparison of three screening implementation models for general population screening. Findings will provide evidence to inform a potential national screening programme for Australian children. ACTRN12622000381785.

Relugolix (Orgovyx)

CADTH recommends that relugolix (Orgovyx) should be reimbursed by public drug plans for the treatment of advanced prostate cancer if certain conditions are met. Orgovyx should only be covered to treat adult patients who have advanced prostate cancer and are not candidates for chemotherapy or surgical therapy soon after initiating treatment. Orgovyx should only be reimbursed if it is prescribed by a clinician with expertise in managing prostate cancer. The cost of Orgovyx should not exceed the drug program cost of treatment with the least costly alternative treatment. Orgovyx should be stopped if the patient experiences severe side effects.

Does an expanded allied health student training programme in regional New South Wales (Australia) result in a positive social return on investment? A protocol for a single-university education-based economic evaluation

Introduction20 years ago, health professional student placements in rural areas of Australia were identified as an important rural recruitment strategy and funding priority. Since then, there has been a growing...

Improving Private Well Testing Programs: Experimental Evidence from Iowa.

Approximately 23 million U.S. households rely on private wells for drinking water. This study first summarizes drinking water behaviors and perceptions from a large-scale survey of households that rely on private wells in Iowa. Few households test as frequently as recommended by public health experts. Around 40% of households do not regularly test, treat, or avoid their drinking water, suggesting pollution exposure may be widespread among this population. Next, we utilize a randomized control trial to study how nitrate test strips and information about a free, comprehensive water quality testing program influence households' behaviors and perceptions. The intervention significantly increased testing, including high-quality follow-up testing, but had limited statistically detectable impacts on other behaviors and perceptions. Households' willingness to pay for nitrate test kits and testing information exceeds program costs, suggesting that the intervention was welfare-enhancing.

Economic evaluation of a psychological surveillance and support programme in the UK police force

PurposePolice officers in the UK frequently experience traumatic events and work pressures, and these can have a detrimental impact on mental health. A psychological surveillance programme has been implemented and clinically evaluated. This paper reports an economic evaluation of the programme.Design/methodology/approachA decision analytic model was developed to explore programme costs, outcomes and return on investment for a notional cohort of 1,000 police personnel (officers and staff). The model parameters were obtained from a large data set of sequential psychological surveillance results. Changes in individual work productivity were derived from a workability measure included in the survey.FindingsThe modelled expected total cost incurred to screen 1,000 participants was £84,287 ($106,971). The expected net increase in work productivity for those receiving interventions was valued at £241,672 ($306,713). This result represents a return on investment of 187%. Sensitivity analyses showed that the model was robust to changes in key parameters.Research limitations/implicationsPolice personnel experiencing traumatic events may need specialist support from occupational health services or psychological therapy. Screening or surveillance can detect mental health problems, but its cost-effectiveness has been previously unknown.Practical implicationsThe value for money of providing surveillance within the police force to detect mental health problems is assessed in this research. The gains in terms of increased work are evident. In similar environmental working conditions, this could extend to emergency services globally.Social implicationsThe police are often called upon to deal with the lowest points in people’s lives. The findings have implications for police forces wishing to support officers to be able to provide the best of themselves in these situations.Originality/valueThere have been no previous studies in policing that have concluded that running a psychological surveillance programme in policing is financially viable. Although this requires initial investment, this paper models that the extra costs incurred are more than offset by improved work productivity.

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

IntroductionVaricella 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 five-year costs of five immunization scenarios were analyzed. MethodsA static decision tree-Markov model was developed in 2022 to assess the cost-effectiveness and five-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 five-year costs were compared with local medical expenditures. ResultsAmong the five scenarios, one dose of routine varicella vaccination was the most cost-saving (USD 70.2) and cost-effective (Dominant) with a five-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 five-year immunization expenditure was USD 19.8 million. The effectiveness and price of vaccines, vaccination coverage, and per capita income are the four main factors that affect ICERs. ConclusionsIn Shanghai, the two 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.