Economic Evaluation of Universal Varicella Vaccination in Mexico

Abstract

Background: Universal varicella vaccination has proven to be cost-effective (CE) in countries where implemented. However, this has not been evaluated for Mexico. Methods: The yearly disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) was derived from Mexican seroprevalence data adjusted to the 2020 population. The yearly economic burden was calculated by combining disease with Mexican unit cost data from both health care and societal perspectives. Four different vaccination strategies were evaluated: (1) 1 dose of varicella vaccine at 1 year old; (2) 2 doses at 1 and 6 years; (3) 1 dose of varicella vaccine at 1 year, and quadrivalent measlesmumps-rubella-varicella vaccine at 6 years; (4) 2 doses of measles-mumpsrubella-varicella vaccine at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. Vaccination impact (number of avoided cases/deaths) was evaluated for a 20-year follow-up period based on vaccine effectiveness (87% and 97.4% for 1 and 2 doses), and assuming a 95% coverage. We estimated annual costs saved, incremental cost-effectiveness ratio, and costs per life year gained. Results: Avoided cases during the 20-year follow-up with 1, and 2 doses were 20,570,722 and 23,029,751, respectively. Strategies 1 and 2 were found to be cost saving, and strategy 3 to be CE. Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 and $34.41 million USD, respectively, to the Mexican society. Conclusions: Universal varicella vaccination, using 1 dose or 2 doses, would result in a cost-beneficial and CE public health intervention in Mexico.

Cobertura y barreras de la vacunación contra la varicela en niños que consultaron a la Fundación Salud Bosque

“…Ha sido demostrado que una sola dosis de la vacuna no es efectiva contra la varicela (34), a comparación de la aplicación de las dos dosis (35), que disminuye severidad (número de lesiones en piel), consultas ambulatorias (36), costos por hospitalización (37) y tasas de hospitalización (35,38), cuya costo efectividad ha sido planteada en China (39), Jordania (40), México (41), Reino Unido (42), Rusia (43), y Suiza (44) si se logra la vacunación universal con cobertura mayor al 90% se reduce la carga de la enfermedad dado los costos derivados de la infección por varicela. En Latinoamérica la varicela genera una carga al sistema de salud (45); en Colombia, de acuerdo con Alvis, se estimó los costos totales hospitalarios directos de varicela complicada en niños colombianos en un estudio realizado en 2011 en $898,766 por cada evento (46), mientras que en Chile el costo directo en el área metropolitana y en Valparaíso ascendió a 2,000,000 pesos colombianos por evento (47).…”

Systematic review of economic evaluations of varicella vaccination programmes

“…Among such studies which reported incremental cost per QALY estimates, there were five full examples [35,[52][53][54][55] and three partial [28,56,57]. Six others with more than one option presented enough information to follow this procedure but did not do so [51,[58][59][60][61][62].…”

“…The latter were confined to childhood vaccination programmes. However, 21 studies of childhood vaccination programmes used a static model [52,54,57,58,60,61,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. No study targeting any other group used a dynamic model.…”