Universal chickenpox vaccination of infants may be cost-saving to society, but better studies are needed

Siriwardena, A. Niroshan

Minster Practice, Lincoln; Clinical research fellow, De Montfort University; Leicester, UK

Abstracted from:Thiry N, Beutels P, Van Dammel P, Van Doorslaer E. Economic evaluations of varicella vaccination programmes. A review of the literature. Pharmacoeconomics 2003; 21: 13-38 .

Sources of funding: This study was financed by a research grant from the Fund for Scientific Research (contract no. 0.0023.01) and the Fund for Specific Research from the University of Antwerp, Belgium (BOF-UA-2001).

Correspondence to: Nancy Thiry, Department of Epidemiology and Social Medicine, Centre for the Evaluation of Vaccination, University of Antwerp, Universiteitsplein 1, Antwerp, 2610, Belgium. E-mail: [email protected].

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(3):p 148-150, September 2003.

BACKGROUND

Chickenpox infections give rise to considerable morbidity and occasional mortality. Many countries are considering vaccination programmes.

OBJECTIVE

To review the methods and results of economic evaluations of varicella vaccination in order to develop local and national vaccination policies.

METHOD

Systematic review of randomised controlled clinical trials.

SEARCH STRATEGY

PubMed, Econlit, Current Contents and Sociofile search, publication dates 1995 to November 2002.

INCLUSION/EXCLUSION CRITERIA

Seventeen economic evaluations of chickenpox vaccination were included. Editorials, letters and partial economic evaluations were excluded, as were two articles that considered passive immunisation with varicella zoster immune globulin.

INTERVENTION

The OKA-strain live attenuated varicella vaccine. In some studies, this was preceded by anamnestic screening (for a past varicella zoster virus infection), serological testing, or both. Studies evaluating children younger than 12 years considered one dose, the others two doses.

MAIN OUTCOMES

Conformity of study design and model characteristics with general guidelines for pharmacoeconomic analyses, and comparison of epidemiological and economic data between studies. Costs were standardised at 1997 US$ to enable comparisons.

MAIN RESULTS

Universal vaccination of infants may result in monetary savings to society because it reduces parental productivity losses. However, universal vaccination is not cost-saving from the perspective of the health-care payer and may increase health-care payer costs, depending on the vaccine price. Adolescent vaccination may provide savings to the health-care payer as well as society, depending on the accuracy of anamnestic screening. Vaccination of health-care workers generated savings from the employer's viewpoint.

AUTHORS' CONCLUSIONS

Studies were of generally low methodological quality, so results must be treated with caution. Studies provide limited evidence that systematic vaccination of children aged 15 months is cost-saving to society. However, this policy may have adverse effects on public health. Studies were based on assumptions regarding the vaccination of infants that, if wrong, could have adverse public health effects. Preadolescent vaccination may be safer and targeted vaccination may be more cost-effective. Further, high quality research is needed, however.