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Varicella Vaccination in Italy

An Economic Evaluation of Different Scenarios

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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.

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

References

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

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

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

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. 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): 383–90

    Article  PubMed  CAS  Google Scholar 

  6. 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): 1288–90

    Article  Google Scholar 

  7. 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): 664–6

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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): 35–44

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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

    Google Scholar 

  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): 142–51

    Article  PubMed  CAS  Google Scholar 

  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): 1306–11

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 542–7

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 763–79

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 631–4

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  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): 414–9

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 81–104

    PubMed  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  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): 843–51

    PubMed  CAS  Google Scholar 

  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): 651–69

    Article  PubMed  CAS  Google Scholar 

  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): 297–304

    Article  PubMed  CAS  Google Scholar 

  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): 21–7

    PubMed  CAS  Google Scholar 

  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): 1091–3

    Article  PubMed  CAS  Google Scholar 

  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): 419–36

    Article  CAS  Google Scholar 

  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): 301–8

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 1041–6

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  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

    Google Scholar 

  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): 120–5

    Article  PubMed  CAS  Google Scholar 

  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: 26–9

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 157–77

    Article  PubMed  CAS  Google Scholar 

  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): 626–7

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 151–6

    Article  PubMed  Google Scholar 

  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): 13–38

    Article  PubMed  Google Scholar 

  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): 1909–15

    Article  PubMed  Google Scholar 

  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): 2375–80

    Article  PubMed  CAS  Google Scholar 

  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): 606–11

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  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): 12648–53

    Article  PubMed  CAS  Google Scholar 

  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): 13–38

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

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

    Google Scholar 

  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: S58–63

    Article  Google Scholar 

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Acknowledgements

Financial support by Aventis Pasteur MSD is acknowledged. The authors would like to thank Nathalie Largeron for her support and Agnieszka Daval for reviewing and assisting in the preparation of this manuscript.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Cresge-Labores, Catholic University of Lille, Lille, France

    Laurent Coudeville, Alain Brunot &  Benoit Dervaux

  2. Department of Paediatrics, University of Padova, Padova, Italy

    Carlo Giaquinto

  3. Adis International, Milano, Italy

    Carlo Lucioni

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  1. Laurent Coudeville
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  2. Alain Brunot
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  3. Carlo Giaquinto
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  4. Carlo Lucioni
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  5. Benoit Dervaux
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Correspondence to Benoit Dervaux.

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Coudeville, L., Brunot, A., Giaquinto, C. et al. Varicella Vaccination in Italy. PharmacoEconomics 22, 839–855 (2004). https://doi.org/10.2165/00019053-200422130-00003

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