Varicella healthcare resource utilization in middle income countries: a pooled analysis of the multi-country MARVEL study in Latin America & Europe

Abstract

Varicella is a mild and self-limited illness in children, but can result in significant healthcare resource utilization (HCRU). To quantify/contrast varicella-associated HCRU in five middle-income countries (Hungary, Poland, Argentina, Mexico, and Peru) where universal varicella vaccination was unimplemented, charts were retrospectively reviewed among 1–14 year-olds. Data were obtained on management of primary varicella between 2009–2016, including outpatient/inpatient visits, allied healthcare contacts, tests/procedures, and medications. These results are contrasted across countries, and a regression model is fit to extrapolated country-level costs as a function of gross domestic product (GDP). A total of 401 outpatients and 386 inpatients were included. Significant differences between countries were observed in the number of skin lesions among outpatients, ranging from 5.3% to 25.4% of patients with ≥250 lesions. Among inpatients, results were less variable. Average ambulatory medical visits ranged from 1.1 to 2.2. Average hospital stay ranged from 3.6 to 6.8 days. Use of tests/procedures was infrequent in outpatients, except in Argentina (13.3%); among inpatients, a test/procedure was ordered for 81.3% of patients, without regional variation. Prescription medications were administered in 44.4% of outpatients (range 9.3%–80.0%), and in 86% of inpatients (range 70.4%–94.9%). Total estimated spending on varicella treatment in the absence of vaccination was predicted from income levels (GDP) with an exponential function (R 2 = 0.89). This study demonstrates that substantial HCRU is associated with varicella resulting in significant public health burden that could be alleviated through the use of varicella vaccination. Differences observed between countries possibly reflect treatment guidelines, healthcare resource availabilities and physician practices.

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“…Differences could be due to methodological differences, i.e., the granularity used in breaking down cost components or country-specific differences, i.e., healthcare expenditure, income levels, country-specific treatment guidelines, healthcare resource availabilities, and physician practices. 23 Pawaskar et al reviewed the economic burden of varicella in Europe. 8 Average LoS was 4.85 days in high-income countries and 5.89 days in low- and middle-income countries and hospitalization costs accounted for 2% to 21% of total costs, including indirect costs.…”

Economic burden of varicella in Bangkok, Thailand: A multicenter medical chart review study

“…Previously, a multi-country study (MARVEL) was conducted to assess HCRU and costs associated with varicella in 5 middle-income countries without UVV (Hungary, Poland, Argentina, Mexico, and Peru, 2009–2016) [ 9 ]. That medical chart review study found that varicella was associated with substantial HCRU and financial burden on health systems.…”