Top

PharmacoEconomics

Published in:

01-09-2004 | Original Research Article

Varicella Vaccination in Italy

An Economic Evaluation of Different Scenarios

Authors: Laurent Coudeville, Alain Brunot, Carlo Giaquinto, Carlo Lucioni, Dr Benoit Dervaux

Published in: PharmacoEconomics | Issue 13/2004

Abstract

Aim: To determine the economic impact (cost-benefit analysis) of childhood varicella vaccination, with the Oka/Merck varicella zoster virus vaccine live (Varivax®) in Italy.

Methods: This analysis is based on an epidemiological model of varicella zoster virus (VZV) dynamics adapted to the Italian situation. Cost data (€, 2002 values) were collected through a literature review. Several vaccination scenarios were analysed: (i) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) without any catch-up programme; (ii) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme for 6-year-old children over the first 5 years of vaccine marketing; and (iii) routine vaccination programme for children aged 1–2 years with different levels of vaccination coverage (90%, 70% and 45%) completed by a catch-up programme during the first year of vaccine marketing for children aged 2–11 years.

Perspectives: A societal perspective, including both direct and indirect costs, and a health-system perspective, limited to costs supported by Italian Health Authorities, were considered.

Results: A routine vaccination programme has a clearly positive impact on chickenpox morbidity. Respectively, 68% and 57% of chickenpox-related hospitalisations and deaths could be prevented with a 90% coverage rate. With vaccination costs being more than offset by a reduction in chickenpox treatment costs in the base case, such a programme could also induce savings from both a societal and a health-system perspective (40% and 12% savings, respectively for a 90% coverage rate). A lower coverage rate reduces cost savings, but there is still a 9% decrease in overall societal costs for a 45% coverage rate. Although the reduction in total societal costs was robust to the sensitivity analyses performed, a slight uncertainty remains regarding cost reduction from a health-system perspective. However, in this latter perspective, even in the worst-case scenario of the sensitivity analysis, routine vaccination programmes may be cost effective, the worst-case scenario for cost parameters leading to cost per life-year gained of €2853. Catch-up programmes combined with routine vaccination should lead to further cost reductions from a societal perspective: 15% for a massive catch-up during the first year of vaccine marketing compared with toddlers’ vaccination alone, and 11% for a catch-up focused on 6-year-old children for a period of 5 years. However, the impact of catch-up programmes on the costs from an Italian health-system perspective remains close to zero (±1%).

Conclusion: This model suggests, with its underlying assumptions and data, that routine ZVZ vaccination may be cost saving from both a societal and a health system perspective in the base case. In the worst-case scenario of the sensitivity analysis, vaccination remains cost effective.

The use of trade names is for product identification purposes only and does not imply endorsement.

Gabutti G, Penna C, Rossi M, et al. The seroepidemiology of varicella in Italy. Epidemiol Infect 2001; 126 (3): 433–40PubMedCrossRef

Deguen S, Chau NP, Flahault A. Epidemiology of chickenpox in France (1991–1995). J Epidemiol Commiruty Health 1998; 52 Suppl. 1: 465–9S

Chao PW, Donahue JG, Manson JE, et al. The epidemiology of varicella and its complications. J Infect Dis 1995; 172 (3): 706–12CrossRef

Yawn BP, Yawn RA, Lydick E. Community impact of childhood varicella infections. J Pediatr 1997; 130 (5): 759–65PubMedCrossRef

Meyer PA, Seward JF, Jumaan AO, et al. Varicella mortality: trends before vaccine licensure in the United States, 1970–1994. J Infect Dis 2000; 182 (2): 383–90PubMedCrossRef

Takahashi M, Otsuka T, Okuno Y, et al. Live vaccine used to prevent the spread of varicella in children in hospital. Lancet 1974; II (7892): 1288–90CrossRef

Barker L, Luman E, Zhao Z, et al. National, state, and urban area vaccination coverage levels among children aged 19–35 months: United States, 2001. MMWR Morb Mortal Wkly Rep 2002; 51 (30): 664–6PubMed

Caraffa De Stefano D, Vellucci L. Proposte per la raccomandazione della vaccinazione antivaricella in Italia. Ann Ig 2002; 14 (4 Suppl. 6): 67–8PubMed

Germinario C, Lopalco PL, Prato R, et al. Target della vaccinazione antivaricella. Ann Ig 2002; 14 (4 Suppl. 6): 55–8PubMed

10.

Salmaso S, Mandolini D, Scalia Tomba G, et al. La prevenzione della varicella in Italia: strategiedi vaccinazione. Ann Ig 2002; 14 (4 Suppl. 6): 35–44PubMed

11.

Banz K, Wagenpfeil S, Neiss A, et al. The cost-effectiveness of routine childhood varicella vaccination in Germany. Vaccine 2003; 21 (11–12): 1256–67PubMedCrossRef

12.

Beutels P, Clara R, Tormans G, et al. Costs and benefits of routine varicella vaccination in German children. J Infect Dis 1996; 174 Suppl. 3: 5335–41

13.

Coudeville L, Paree F, Lebrun T, et al. The value of varicella vaccination in healthy children: cost-benefit analysis of the situation in France. Vaccine 1999; 17 (2): 142–51PubMedCrossRef

14.

Diez Domingo J, Ridao M, Latour J, et al. A cost benefit analysis of routine varicella vaccination in Spain. Vaccine 1999; 17 (11–12): 1306–11PubMedCrossRef

15.

Gray AM, Fenn P, Weinberg J, et al. An economic analysis of varicella vaccination for health care workers. Epidemiol Infect 1997; 119 (2): 209–20PubMedCrossRef

16.

O’Neill J, Buttery J. Varicella and paediatric staff: current practice and vaccine cost-effectiveness. J Hosp Infect 2003; 53 (2), 117–9PubMedCrossRef

17.

Brisson M, Edmunds WJ. The cost-effectiveness of varicella vaccination in Canada. Vaccine 2002; 20 (7–8): 1113–25PubMedCrossRef

18.

Getsios D, Caro JJ, Caro G, et al. Instituting a routine varicella vaccination program in Canada: an economic evaluation. Pediatr Infect Dis J 2002; 21 (6): 542–7PubMedCrossRef

19.

Scuffham PA, Lowin AV, Burgess MA. The cost-effectiveness of varicella vaccine programmes for Australia. Vaccine 1999; 18 (5–6): 407–15PubMedCrossRef

20.

Scuffham P, Devlin N, Eberhart-Phillips J, et al. The cost-effectiveness of introducing a varicella vaccine to the New Zealand immunisation schedule. Soc Sci Med 1999; 49 (6): 763–79PubMedCrossRef

21.

Lieu TA, Cochi SL, Black SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994; 271 (5): 375–81PubMedCrossRef

22.

Huse DM, Meissner HC, Lacey MJ, et al. Childhood vaccination against chickenpox: an analysis of benefits and costs. J Pediatr 1994; 124 (6): 869–74PubMedCrossRef

23.

Burnham BR, Wells TS, Riddle JR. A cost-benefit analysis of a routine varicella vaccination program for United States Air Force Academy cadets. Mil Med 1998; 163 (9): 631–4PubMed

24.

Zotti CM, Maggiorotto G, Migliardi A. I costi della varicella. Ann Ig 2002; 14 (4 Suppl. 6): 29–33PubMed

25.

Fornaro P, Gandini F, Marin M, et al. Epidemiology and cost analysis of varicella in Italy: results of a sentinel study in the pediatric practice. Italian Sentinel Group on Pediatric Infectious Diseases. Pediatr Infect Dis J 1999; 18 (5): 414–9PubMedCrossRef

26.

Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child 2003; 88 (10): 862–9PubMedCrossRef

27.

Halloran ME, Cochi SL, Lieu TA, et al. Theoretical epidemiologic and morbidity effects of routine varicella immunization of preschool children in the United States. Am J Epidemiol 1994; 140 (2): 81–104PubMed

28.

Halloran ME. Epidemiologic effects of varicella vaccination. Inf Dis Clin North Am 1996; 10 (3): 631–55CrossRef

29.

ISTAT. Annuario Statistico Italiano; 2001 [online]. Available from URL: http://www.istatit [Accessed 2001 December]

30.

Salmaso S, Rota M, Ciofi Degli Atti L, et al. Infant immunization coverage in Italy: estimates by sirmltaneous EPI cluster surveys of regions. Bull World Health Organ 1999; 77 (10): 843–51PubMed

31.

Brisson M, Edmunds WJ, Gay NJ, et al. Modelling the impact of immunization on the epidemiology of varicella zoster virus. Epidemiol Infect 2000; 125 (3): 651–69PubMedCrossRef

32.

Vessey SJ, Chan CY, Kuter BJ, et al. Childhood vaccination against varicella: persistence of antibody, duration of protection, and vaccine efficacy. J Pediatr 2001; 139 (2): 297–304PubMedCrossRef

33.

Giaquinto C, Sturkenboom M, Mannino S, et al. Epidemiologia ed esiti della varicella in ltalia: risultati di uno studio prospettico sui bambini (0–14 anni) seguiti dai pediatri di libera scelta (studio pedianet). Ann Ig 2002; 14 (4 Suppl. 6): 21–7PubMed

34.

Rawson H, Crampin A, Noah N. Deaths from chickenpox in England and Wales 1995–7: analysis of routine mortality data. BMJ 2001; 323 (7321): 1091–3PubMedCrossRef

35.

Grenfell BT, Anderson RM. The estimation of age-related rates of infection from case notifications and serological data. J Hyg (Lond) 1985; 95 (2): 419–36CrossRef

36.

Johansson LA, Westerling R. Comparing hospital discharge records with death certificates: can the differences be explained? J Epidemiol Comminlty Health 2002 Apr; 56 (4): 301–8CrossRef

37.

Messite J, Stellman SD. Accuracy of death certificate completion: the need for formalized physician training. JAMA 1996 Mar 13; 275 (10): 794–6PubMedCrossRef

38.

Sharrar RG, LaRussa P, Galea SA, et al. The postmarketing safety profile of varicella vaccine. Vaccine 2000; 19 (7–8): 916–23PubMedCrossRef

39.

Izurieta HS, Strebel PM, Blake PA. Postlicensure effectiveness of varicella vaccine during an outbreak in a child care center. JAMA 1997; 278 (18): 1495–9PubMedCrossRef

40.

Black S, Shinefield H, Ray P, et al. Postmarketing evaluation of the safety and effectiveness of varicella vaccine. Pediatr Infect Dis J 1999; 18 (12): 1041–6PubMedCrossRef

41.

Drummond MF, Stoddard GL. Methods for the economic evaluations of health care programmes. Oxford: Oxford University Press, 1987

42.

Lucioni C, Cirrimina S, Di Carlo P, et al. II costo sociale del morbillo in eta pediatrica: l’epidemia a Palermo nel 1996–97. Pharmacoeconomics Italian Research Articles 1999; 1 (1): 17–33

43.

Gruppo di lavoro ICONA. Indagine nazionale sulla copertura vaccinale infantile. Rapporto ISTISAN (Isituto Superiore di Sanita) 1998; 98/33 (viii): 123

44.

Lieu TA, Black SB, Takahashi H, et al. Varicella serology among school age children with a negative or uncertain history of chickenpox. Pediatr Infect Dis J 1998 Feb; 17 (2): 120–5PubMedCrossRef

45.

Harel Z, Ipp L, Riggs S, et al. Serotesting versus presumptive varicella vaccination of adolescents with a negative or uncertain history of chickenpox. J Adolesc Health 2001; 28: 26–9PubMedCrossRef

46.

Garattini L, Grilli R, Scopelliti D, et al. A proposal for Italian Guidelines in pharmacoeconomics. Pharmacoeconomics 1995; 7: 1–6PubMedCrossRef

47.

Doubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation: a practical approach. Med Decis Making 1985; 5 (2): 157–77PubMedCrossRef

48.

Walter EB, Simmons SS, Bland CL, et al. Modified varicella-like syndrome in children previously vaccinated with live attenuated measles, mumps, rubella and varicella vaccine. Pediatr Infect Dis J 1997; 16 (6): 626–7PubMedCrossRef

49.

Clements DA. Modified varicella-like syndrome. Infect Dis Clin North Am 1996; 10 (3): 617–29PubMedCrossRef

50.

Tseng HF, Tan HF, Chang CK. Varicella vaccine safety, incidence of breakthrough, and factors associated with breakthrough in Taiwan. Am J Infect Control 2003; 31 (3): 151–6PubMedCrossRef

51.

Thiry N, Beutels P, Van Damme P, et al. Economic evaluations of varicella vaccination programmes: a review of the literature. Pharmacoeconomics 2003; 21 (1): 13–38PubMedCrossRef

52.

Galil K, Lee B, Strine T, et al. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med. 2002 Dec 12; 347 (24): 1909–15PubMedCrossRef

53.

Ozaki T, Nishimira N, Kajita Y. Experience with live attenuated varicella vaccine (Oka strain) in healthy Japanese subjects: lO-year survey at pediatric clinic. Vaccine 2000; 18 (22): 2375–80PubMedCrossRef

54.

Seward JF, Watson BM, Peterson CL, et al. Varicella disease after introduction of varicella vaccine in the United States, 1995–2000. JAMA 2002; 287 (5): 606–11PubMedCrossRef

55.

Krause PR, Klinman DM. Varicella vaccination: evidence for frequent reactivation of the vaccine strain in healthy children. Nat Med 2000; 6 (4): 451–4PubMedCrossRef

56.

Bolker BM, Grenfell BT. Impact of vaccination on the spatial correlation and persistence of measles dynamics. Proc Natl Acad Sci U S A. 1996 Oct 29; 93 (22): 12648–53PubMedCrossRef

57.

Thiry N, Beutels P, Van Damme P, et al. Economic evaluations of varicella vaccination programmes: a review of the literature. Pharmacoeconomics 2003; 21 (1): 13–38PubMedCrossRef

58.

Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child 2003; 88: 862–9PubMedCrossRef

59.

Edmunds WJ, Brisson M, Gay NJ, et al. Varicella vaccination: a double-edged sword? Commun Dis Public Health 2002; 5 (3): 185–6PubMed

60.

Gershon AA, Takahashi M, White CJ. Varicella vaccine. In: Plotkin SA, editor. Vaccines. 3rd ed. Philadelphia (PA): WB Saunders, 1999: 475–507

61.

Nikas AA, Coplan PM, Kaplan KM, et al. Herpes zoster hospitalisation rates: 1990–2000. 21st annual meeting of the European Society for Pediatric and Infectious Diseases; 2003, 11

62.

Levy-Bruhl D, Pebody R, Veldhuijzen I, et al. ESEN: acomparison of vaccination programmes. Part three: measles mumps and rubella. Euro Surveill1998; 3 (12): 115–9

63.

Saddier P, Floret D, Guess HA, et al. Cost of varicella in France: a study in day care centers. J InfDis 1998; 178 Suppl. 1: S58–63CrossRef

Title: Varicella Vaccination in Italy
An Economic Evaluation of Different Scenarios
Authors: Laurent Coudeville
Alain Brunot
Carlo Giaquinto
Carlo Lucioni
Dr Benoit Dervaux
Publication date: 01-09-2004
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 13/2004
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200422130-00003

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Varicella Vaccination in Italy

An Economic Evaluation of Different Scenarios

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 13/2004

Acute Rhinosinusitis

A Decision Chart for Assessing and Improving the Transferability of Economic Evaluation Results Between Countries

Transferability of Economic Evaluation Results

Cost Effectiveness of Ibutilide With Prophylactic Magnesium in the Treatment of Atrial Fibrillation

Pharmacoeconomic Analysis of Bemiparin and Enoxaparin as Prophylaxis for Venous Thromboembolism in Total Knee Replacement Surgery