Impact of universal varicella vaccination on the use and cost of antibiotics and antivirals for varicella management in the United States

Abstract

Background Our objective was to estimate the impact of universal varicella vaccination (UVV) on the use and costs of antibiotics and antivirals for the management of varicella among children in the United States (US). Methods A decision tree model of varicella vaccination, infections and treatment decisions was developed. Results were extrapolated to the 2017 population of 73.5 million US children. Model parameters were populated from published sources. Treatment decisions were derived from a survey of health care professionals’ recommendations. The base case modelled current vaccination coverage rates in the US with additional scenarios analyses conducted for 0%, 20%, and 80% coverage and did not account for herd immunity benefits. Results Our model estimated that 551,434 varicella cases occurred annually among children ≤ 18 years in 2017. Antivirals or antibiotics were prescribed in 23.9% of cases, with unvaccinated children receiving the majority for base case. The annual cost for varicella antiviral and antibiotic treatment was approximately $14 million ($26 per case), with cases with no complications accounting for $12 million. Compared with the no vaccination scenario, the current vaccination rates resulted in savings of $181 million (94.7%) for antivirals and $78 million (95.0%) for antibiotics annually. Scenario analyses showed that higher vaccination coverage (from 0% to 80%) resulted in reduced annual expenditures for antivirals (from $191 million to $41 million), and antibiotics ($82 million to $17 million). Conclusions UVV was associated with significant reductions in the use of antibiotics and antivirals and their associated costs in the US. Higher vaccination coverage was associated with lower use and costs of antibiotics and antivirals for varicella management.

Assessing the use of antibiotics in pediatric patients hospitalized for varicella

“…This data is even more interesting when considered on a large scale. Scenario analyses comparing no vaccination versus universal vaccination, showed that higher vaccination coverage was also cost saving, reducing annual expenditures for antibiotics in the United States from $82 million to $17 million [ 13 ].…”

“…Universal varicella vaccination is currently recommended in 12 European countries and mandatory only in Italy, Hungary and Latvia [ 12 ]. The impact of vaccination not only guarantees a protection from the viral disease, but is also associated with reduction in the use of antibiotics, in the costs for varicella management and in the spread of antimicrobial resistance [ 13 – 15 ].…”

The short and long‐term impact of nonpharmaceutical interventions on the prevalence of varicella in Xi'an during the COVID‐19 pandemic

“…5 Moreover, implementing universal varicella vaccination in the United States has significantly reduced the annual use of antibiotics and antivirals and their associated costs for children. 6 In China, VarV was first used in 1998, and the current vaccination procedure is to administer one dose of VarV to children above 12 months. 7 However, the varicella vaccine is still self-financed in China.…”

“…Varicella vaccine (VarV) is the most effective and economical measure to prevent and control the occurrence of varicella epidemics 5 . Moreover, implementing universal varicella vaccination in the United States has significantly reduced the annual use of antibiotics and antivirals and their associated costs for children 6 . In China, VarV was first used in 1998, and the current vaccination procedure is to administer one dose of VarV to children above 12 months 7 .…”

Available evidence and potential for vaccines for reduction in antibiotic prescriptions

“…The impact of universal varicella vaccination on the use and cost of antibiotics and antivirals for varicella management has been evaluated in the USA pointing out that high vaccination coverage rates would imply a significant reduction in annual antibiotic and antiviral use. 49 …”