Wutzler Peter, Neiss Albrecht, Banz Kurt, Goertz Anita, Bisanz Helmtrud
Institute for Antiviral Chemotherapy, Friedrich-Schiller University of Jena, Winzerlaer Strasse 10, Germany.
Med Microbiol Immunol. 2002 Oct;191(2):89-96. doi: 10.1007/s00430-002-0123-4. Epub 2002 Aug 29.
Varicella is a potentially serious infection not only in immunocompromised individuals but also in otherwise healthy adults and children. Vaccination plays an important role in preventing the disease and its sequelae. A universal vaccination in childhood is expected to reduce substantially the number of uncomplicated cases of varicella and decrease the number of complicated cases requiring hospitalisation. To generate data as basis for decisions of the health authorities concerning prevention of varicella, epidemiological and health-economic data were collected in two studies. Using an age-structured decision analytic model the benefits, costs and cost effectiveness of a varicella immunisation program for a period of 30 years were assessed. It was shown that after the first year of life seroprevalence rates increased steadily and reached 62% among the 4- to 5-year olds and 94% among the 10- to 11-year olds, respectively; 90% of varicella patients were younger than 12 years. A severe course was assessed for 16.3% of the cases. Overall incidence of complications was estimated to be 5.7%. A routine varicella vaccination program targeting healthy children could prevent 82.7% of varicella cases and over 4,700 major complications per year provided the coverage level was 85%. Under these conditions the elimination of varicella is predicted to be achievable within 18 years. It is expected that a combined measles, mumps, rubella and varicella vaccine could provide the required coverage. Average yearly discounted net cost savings of universal childhood vaccination are 51 million Euro with a benefit-cost ratio of 4.12. Childhood vaccination with catch-up of adolescents provides additional clinical benefits. The break-even point indicating first net savings could be achieved already 3 years after the implementation of the vaccination program. In summary, routine childhood varicella vaccination appears to be a highly efficient strategy to significantly reduce the sizeable burden of varicella and would lead to net savings from both the societal but also the payer perspective.
水痘不仅在免疫功能低下的个体中是一种潜在的严重感染，在其他方面健康的成年人和儿童中也是如此。疫苗接种在预防该疾病及其后遗症方面发挥着重要作用。儿童期普遍接种疫苗有望大幅减少水痘的非复杂病例数量，并减少需要住院治疗的复杂病例数量。为了生成数据作为卫生当局关于预防水痘决策的依据，在两项研究中收集了流行病学和卫生经济数据。使用年龄结构决策分析模型评估了为期30年的水痘免疫计划的益处、成本和成本效益。结果表明，出生后第一年血清阳性率稳步上升，在4至5岁儿童中达到62%，在10至11岁儿童中达到94%；90%的水痘患者年龄小于12岁。16.3%的病例被评估为重症病程。并发症的总体发生率估计为5.7%。针对健康儿童的常规水痘疫苗接种计划如果覆盖率达到85%，每年可预防82.7%的水痘病例和超过4700例主要并发症。在这些条件下，预计18年内可实现水痘的消除。预计联合麻疹、腮腺炎、风疹和水痘疫苗可提供所需的覆盖率。儿童期普遍接种疫苗每年平均贴现净成本节省为5100万欧元，效益成本比为4.12。青少年补种的儿童期疫苗接种可带来额外的临床益处。实施疫苗接种计划3年后即可实现首次净节省的盈亏平衡点。总之，儿童期常规水痘疫苗接种似乎是一种高效策略，可显著减轻水痘带来的巨大负担，从社会和支付方的角度来看都将带来净节省。
