a Center for Observational and Real-World Evidence , Merck & Co., Inc ., Kenilworth , NJ , USA.
b Instituto Nacional de Salud del Niño (INSN) , Breña , Perú.
Hum Vaccin Immunother. 2019;15(4):932-941. doi: 10.1080/21645515.2018.1559687. Epub 2019 Feb 20.
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 = 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.
水痘在儿童中是一种轻度且自限性疾病，但会导致大量医疗保健资源利用（HCRU）。为了量化/对比在未实施普遍水痘疫苗接种的五个中等收入国家（匈牙利、波兰、阿根廷、墨西哥和秘鲁）中与水痘相关的 HCRU，对 1-14 岁儿童进行了回顾性图表审查。获得了 2009-2016 年期间原发性水痘管理的数据，包括门诊/住院就诊、辅助医疗接触、检查/程序和药物。这些结果在国家之间进行了对比，并拟合了回归模型，以国内生产总值（GDP）为函数外推国家层面的成本。共纳入 401 名门诊患者和 386 名住院患者。在门诊患者的皮损数量方面观察到国家之间存在显著差异，从≥250 个皮损的患者中，有 5.3%到 25.4%的患者存在皮损。在住院患者中，结果的差异较小。门诊平均就诊次数范围为 1.1 到 2.2 次。住院平均住院天数为 3.6 到 6.8 天。门诊患者很少进行检查/程序，除了阿根廷（13.3%）；住院患者中，81.3%的患者都有检查/程序，且无地域差异。44.4%的门诊患者（范围为 9.3%-80.0%）和 86%的住院患者（范围为 70.4%-94.9%）接受了处方药物治疗。使用指数函数（R = 0.89）根据收入水平（GDP）预测在没有疫苗接种的情况下治疗水痘的总估计支出。这项研究表明，水痘会导致大量的 HCRU，给公共卫生带来重大负担，而水痘疫苗的使用可以缓解这一负担。在国家之间观察到的差异可能反映了治疗指南、医疗资源的可利用性和医生的实践。
