Zhou Fangjun, Harpaz Rafael, Jumaan Aisha O, Winston Carla A, Shefer Abigail
National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
JAMA. 2005 Aug 17;294(7):797-802. doi: 10.1001/jama.294.7.797.
Since varicella vaccine was first recommended for routine immunization in the United States in 1995, the incidence of disease has dropped substantially. However, national surveillance data are incomplete, and comprehensive data regarding outpatient as well as hospital utilization have not been reported.
To examine the impact of the varicella vaccination program on medical visits and associated expenditures.
DESIGN, SETTING, AND PATIENTS: Retrospective population-based study examining the trends in varicella health care utilization, based on data from the MarketScan databases, which include enrollees (children and adults) of more than 100 health insurance plans of approximately 40 large US employers, from 1994 to 2002.
Trends in rates of varicella-related hospitalizations and ambulatory visits and direct medical expenditures for hospitalizations and ambulatory visits, analyzed using 1994 and 1995 as the prevaccination baseline.
From the prevaccination period to 2002, hospitalizations due to varicella declined by 88% (from 2.3 to 0.3 per 100,000 population) and ambulatory visits declined by 59% (from 215 to 89 per 100,000 population). Hospitalizations and ambulatory visits declined in all age groups, with the greatest declines among infants younger than 1 year. Total estimated direct medical expenditures for varicella hospitalizations and ambulatory visits declined by 74%, from an average of 84.9 million dollars in 1994 and 1995 to 22.1 million dollars in 2002.
Since the introduction of the varicella vaccination program, varicella hospitalizations, ambulatory visits, and their associated expenditures have declined dramatically among all age groups in the United States.
自1995年水痘疫苗首次在美国被推荐用于常规免疫接种以来，该病的发病率已大幅下降。然而，国家监测数据并不完整，关于门诊和住院利用情况的综合数据尚未报告。
研究水痘疫苗接种计划对医疗就诊及相关费用的影响。
设计、地点和患者：基于市场扫描数据库的数据进行的一项回顾性人群研究，该数据库包括美国约40家大型雇主的100多个医疗保险计划的参保者（儿童和成人），时间跨度为1994年至2002年，研究水痘医疗利用情况的趋势。
以1994年和1995年作为接种疫苗前的基线，分析水痘相关住院率和门诊就诊率的趋势，以及住院和门诊就诊的直接医疗费用。
从接种疫苗前到2002年，水痘导致的住院率下降了88%（从每10万人2.3例降至0.3例），门诊就诊率下降了59%（从每10万人215例降至89例）。所有年龄组的住院率和门诊就诊率均下降，其中1岁以下婴儿下降幅度最大。水痘住院和门诊就诊的估计直接医疗总费用下降了74%，从1994年和1995年的平均8490万美元降至2002年的2210万美元。
自水痘疫苗接种计划实施以来，美国所有年龄组的水痘住院率、门诊就诊率及其相关费用均大幅下降。
