From the University of Basel Children's Hospital, Basel, Switzerland.
Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, New Jersey.
Pediatr Infect Dis J. 2021 Jun 1;40(6):e217-e221. doi: 10.1097/INF.0000000000003136.
Varicella, caused by the varicella-zoster virus, is a highly contagious infectious disease with substantial health and economic burden to society. Universal varicella vaccination (UVV) is not yet recommended by the Swiss National Immunization Program, which instead recommends catch-up immunization for children, adolescents and adults 11-40 years of age who have no reliable history of varicella or are varicella-zoster virus-IgG seronegative. The objective of this study was to perform an assessment of health impact and cost-effectiveness comparing UVV with current practice and recommendations in Switzerland.
A dynamic transmission model for varicella was adapted to Switzerland comparing 2 base-case schedules (no infant vaccination and 10% coverage with infant vaccination) to 3 different UVV schedules using quadrivalent (varicella vaccine combined with measles-mumps-rubella) and standalone varicella vaccines administered at different ages. Modeled UVV coverage rates were based on current measles-mumps-rubella coverage of approximately 95% (first dose) and 90% (second dose). Direct medical costs and societal perspectives were considered, with cost and outcomes discounted and calculated over a 50-year time horizon.
UVV would reduce the number of varicella cases by 88%-90%, hospitalizations by 62%-69% and deaths by 75%-77%. UVV would increase direct medical costs by Swiss Franc (CHF) 39-49 (US $43-54) per capita and costs from a societal perspective by CHF 32-40 (US $35-44). Incremental quality-adjusted life-years per capita increased by 0.0012-0.0014. Incremental cost-effectiveness ratios for the UVV schedules versus the base-case were CHF 31,194-35,403 (US $34,452-39,100) per quality-adjusted life-year from the direct medical cost perspective and CHF 25,245-29,552 (US $27,881-32,638) from the societal perspective.
UVV appears highly effective and cost-effective when compared with current clinical practice and recommendations in Switzerland from both a direct medical costs perspective and societal perspective.
水痘是由水痘带状疱疹病毒引起的一种高度传染性传染病，对社会的健康和经济造成了重大负担。瑞士国家免疫计划尚未推荐普遍接种水痘疫苗（UVV），而是建议为 11-40 岁无可靠水痘病史或水痘带状疱疹病毒 IgG 阴性的儿童、青少年和成年人进行补种免疫。本研究旨在评估与瑞士目前的实践和建议相比，UVV 的健康影响和成本效益。
我们对瑞士的水痘进行了动态传播模型的适应性研究，将两种基本方案（无婴儿接种和 10%婴儿接种覆盖率）与使用四价（水痘疫苗与麻疹-腮腺炎-风疹联合）和单价水痘疫苗在不同年龄接种的三种不同 UVV 方案进行了比较。模型化的 UVV 覆盖率基于目前麻疹-腮腺炎-风疹疫苗的覆盖率约为 95%（第一剂）和 90%（第二剂）。我们考虑了直接医疗成本和社会观点，对成本和结果进行了折扣，并在 50 年的时间内进行了计算。
UVV 将使水痘病例减少 88%-90%，住院减少 62%-69%，死亡减少 75%-77%。UVV 将使人均直接医疗成本增加 39-49 瑞士法郎（43-54 美元），从社会角度来看，成本将增加 32-40 瑞士法郎（35-44 美元）。人均增量质量调整生命年增加 0.0012-0.0014。从直接医疗成本角度来看，UVV 方案与基础方案相比，增量成本效益比为 31194-35403 瑞士法郎（34452-39100 美元）/质量调整生命年，从社会角度来看，增量成本效益比为 25245-29552 瑞士法郎（27881-32638 美元）/质量调整生命年。
从直接医疗成本和社会角度来看，UVV 与瑞士目前的临床实践和建议相比，具有较高的有效性和成本效益。
