Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

Pawaskar, Manjiri; Burgess, Colleen; Pillsbury, Mathew; Wisløff, Torbjørn; Flem, Elmira

doi:10.1371/journal.pone.0254080

Cited by 14 publications

(15 citation statements)

References 39 publications

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“…The model described here has been reviewed for accuracy and epidemiological appropriateness, and the results are consistent with previous model adaptations performed for Italy, Norway, and Turkey. 23,38,40 In addition, results of this model are consistent with real-world observational studies showing the impact of UVV in countries such as Italy and the United States. [41][42][43] Comparing the economic impact of vaccination between countries can be challenging given the heterogeneity in varicella infection reporting and differences in health care systems and vaccine pricing across countries.…”

Section: Discussionsupporting

confidence: 86%

“…39 Finally, in Norway, 2-dose UVV was predicted to result in substantial reductions in outpatient cases, hospitalizations, and deaths, and was cost-effective vs no vaccination from payer and societal perspectives over the 50-year time horizon. 40 Most of the projected cost savings from the societal perspective were due to reductions in lost workdays. 40 In this study, all vaccination strategies were cost-saving compared with the no-vaccination strategy from the societal perspective, with indirect costs constituting a significant proportion of the societal costs associated with varicella.…”

Section: Discussionmentioning

confidence: 99%

“…40 Most of the projected cost savings from the societal perspective were due to reductions in lost workdays. 40 In this study, all vaccination strategies were cost-saving compared with the no-vaccination strategy from the societal perspective, with indirect costs constituting a significant proportion of the societal costs associated with varicella. MSD strategies were more cost-effective than corresponding GSK strategies from the payer perspective, and more cost-saving from the societal perspective.…”

Section: Discussionmentioning

confidence: 99%

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The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

Burgess

Kujawski

Lapornik³

et al. 2022

Journal of Health Economics and Outcomes Research

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Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

Burgess

Kujawski

Lapornik³

et al. 2022

Journal of Health Economics and Outcomes Research

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“…The burden of varicella in a primary care setting in Belgium is substantial, with high rates of complications as well as high rate of antibiotics use. To reduce the number of varicella cases and clinical and economic burden of varicella disease, including antibiotics use, policy makers may consider a UVV strategy [ 5 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

Vandenhaute

Tsakeu²,

Chevalier³

et al. 2021

BMC Infect Dis

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Background Varicella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur. Objectives The objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits. Methods The study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period. Results 3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP. Conclusions This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

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“… Halloran et al (1994) showed that the number of older susceptible children increased after initiation of a varicella vaccination program, and that this effect became more apparent as vaccine coverage increased. Many followers assessed the impact of universal varicella immunization on the incidence of varicella ( Brisson et al, 2000 ; Karsai et al, 2020 ; Pawaskar et al, 2021 ; Suh et al, 2021 ; van Hoek et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Reconstructing the transmission dynamics of varicella in Japan: an elevation of age at infection

Suzuki¹,

Nishiura²

2022

PeerJ

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Background In Japan, routine two-dose immunization against varicella has been conducted among children at ages of 12 and 36 months since 2014, and the vaccination coverage has reached around 90%. To understand the impact of routine varicella vaccination, we reconstructed the epidemiological dynamics of varicella in Japan. Methods Epidemiological and demographic datasets over the past three decades were analyzed to reconstruct the number of susceptible individuals by age and year. To estimate the annual risk of varicella infection, we fitted a balance equation model to the annual number of cases from 1990 to 2019. Using parameter estimates, we reconstructed varicella dynamics starting from 1990 and modeled future dynamics until 2033. Results Overall varicella incidence declined over time and the annual risk of infection among children younger than 10 years old decreased monotonically starting in 2014. Conversely, varicella incidence among teenagers (age 10 to 14 years) has increased each year since 2014. A substantial number of unvaccinated individuals born before the routine immunization era remained susceptible and aged without contracting varicella, while the annual risk of infection among teenagers aged 10 to 14 years increased starting in 2011 despite gradual expansion of varicella vaccine coverage. The number of susceptible individuals decreased over time in all age groups. Modeling indicated that susceptibility rates among pre-school children aged 1 to 4 years will remain low. Conclusion Routine varicella vaccination has successfully reduced infections in pre-school and early primary school age children, but has also resulted in increased infection rates among adolescents. This temporary increase was caused both by the increased age of susceptible individuals and increased transmission risk among adolescents resulting from the dynamic nature of varicella transmission. Monitoring susceptibility among adolescents will be important to prevent outbreaks over the next decade.

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Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

Cited by 14 publications

References 39 publications

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis

Reconstructing the transmission dynamics of varicella in Japan: an elevation of age at infection

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