Assessment of the Clinical and Economic Impact of Different Immunization Protocols of Measles, Mumps, Rubella and Varicella in Internationally Adopted Children

Abstract

The appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested. The aim of this study is to evaluate the clinical and economic impact of different strategies of measles, mumps, rubella, and varicella (MMRV) immunization in IAC in Italy. A decision analysis model was developed to compare three strategies: presumptive immunization, pre-vaccination serotesting and vaccination based on documentation of previous immunization. Main outcomes were the cost of strategy, number of protected IAC, and cost per child protected against MMRV. Moreover, the incremental cost-effectiveness ratio (ICER) was calculated. The strategy currently recommended in Italy (immunize based on documentation) is less expensive. On the other hand, the pre-vaccination serotesting strategy against MMRV together, improves outcomes with a minimum cost increase, compared with the presumptive immunization strategy and compared with the comparator strategy. From a cost-effectiveness point of view, vaccination based on serotesting results in being the most advantageous strategy compared to presumptive vaccination. By applying a chemiluminescent immunoassay test, the serology strategy resulted to be clinically and economically advantageous. Similar results were obtained excluding children aged <1 year for both serology methods. In conclusion, based on our analyses, considering MMRV vaccine, serotesting strategy appears to be the preferred option in IAC.

Systematic review of economic evaluations of varicella vaccination programmes

“…One provided a formula for determining the choice [ 34 ]. Another showed an incremental cost of £394 per case prevented with testing [ 32 ]. A third reported an incremental cost per QALY gained of £10,816 for presumptive vaccination against testing and vaccinating susceptibles [ 35 ].…”

“…These studies tended to be the most recently published, with an average publication date of 2015. 26 ; susceptible children adopted from abroad 1-18 years old 32 One dose 26 , two doses 32 All newly arriving asylum seekers age 15−39 33 Vaccination of all susceptible in response to outbreak. Two doses vs usual response 33 Switzerland Cost per person 167% higher 33 n/a Primigravidae born in UK or Bangladesh 37 Two doses vs no vaccination UK Verbal screening followed by serotesting may be cost-saving to the NHS for both UK-and Bangladesh-born primigravidae 37 n/a Susceptible schoolchildren 6-12 and adolescents 13−17 25 ; 20 year olds and older 28 ; susceptible children eligible for kidney transplant 30 ; recently arrived refugees 1 to 20 years of age 34 ; women 15-49 postpartum 36 ; women postpartum 38 One dose vs no vaccination 25 ; two doses vs no vaccination 28 ; Pretreatment vaccination two doses vs usual care 30 ; One dose under 13, two doses 13 and over vs no vaccination 34 ; two doses vs no vaccination 36…”

“…There were studies in high risk or otherwise special groups: those eligible for organ transplants-children [29] and adults [30]; paediatric patients [31]; recent immigrants, refugees or children adopted from abroad [32][33][34][35]; susceptible adults [28] and children aged six or over [25]; adolescents [26], other adults [27]; and women pre-or post-partum [36][37][38]. Ten studies focused on the workplace, four on military personnel [39][40][41][42] and six on healthcare staff [43][44][45][46][47][48].…”

Vaccination and Vaccine Effectiveness: A Commentary of Special Issue Editors

“…Among IAC with an unknown protective status against MMRV, as reported by Boccalini et al, a vaccination strategy based on serotesting results was the most advantageous approach, economically and clinically [ 19 ]. Moreover, another multicenter study conducted ina Northern (Liguria) and a Southern (Apulia) Italian region found poor knowledge but good attitudes among undergraduates about HPV vaccination [ 20 ].…”

Model Comparisons of the Cost Effectiveness of Rubella Vaccination Method in Japanese Adults

“…Furthermore, Boccalini et al economically analyzed the appropriate vaccinations for internationally adopted children in Italy. They concluded that antibody testing was more efficacious [ 12 ]. Meanwhile, Asli et al concluded in the study of health care workers and students in Turkey that it is better to get the rubella vaccine without the screening tests [ 13 ].…”