scholarly journals Clinical and economic impact of universal varicella vaccination in Norway: A modeling study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254080
Author(s):  
Manjiri Pawaskar ◽  
Colleen Burgess ◽  
Mathew Pillsbury ◽  
Torbjørn Wisløff ◽  
Elmira Flem
Keyword(s):  
Cost Saving ◽  
Varicella Vaccine ◽  
Vaccination Strategy ◽  
Quadrivalent Vaccine ◽  
Transmission Model ◽  
Varicella Vaccination ◽  
Vaccination Strategies ◽  
Dynamic Transmission Model ◽  
Life Years ◽  
The Impact

Background Norway has not implemented universal varicella vaccination, despite the considerable clinical and economic burden of varicella disease. Methods An existing dynamic transmission model of varicella infection was calibrated to age-specific seroprevalence rates in Norway. Six two-dose vaccination strategies were considered, consisting of combinations of two formulations each of a monovalent varicella vaccine (Varivax® or Varilrix®) and a quadrivalent vaccine against measles-mumps-rubella-varicella (ProQuad® or PriorixTetra®), with the first dose given with a monovalent vaccine at age 15 months, and the second dose with either a monovalent or quadrivalent vaccine at either 18 months, 7 or 11 years. Costs were considered from the perspectives of both the health care system and society. Quality-adjusted life-years saved and incremental cost-effectiveness ratios relative to no vaccination were calculated. A one-way sensitivity analysis was conducted to assess the impact of vaccine efficacy, price, the costs of a lost workday and of inpatient and outpatient care, vaccination coverage, and discount rate. Results In the absence of varicella vaccination, the annual incidence of natural varicella is estimated to be 1,359 per 100,000 population, and the cumulative numbers of varicella outpatient cases, hospitalizations, and deaths over 50 years are projected to be 1.81 million, 10,161, and 61, respectively. Universal varicella vaccination is projected to reduce the natural varicella incidence rate to 48–59 per 100,000 population, depending on the vaccination strategy, and to reduce varicella outpatient cases, hospitalizations, and deaths by 75–85%, 67–79%, and 75–79%, respectively. All strategies were cost-saving, with the most cost-saving as two doses of Varivax® at 15 months and 7 years (payer perspective) and two doses of Varivax® at 15 months and 18 months (societal perspective). Conclusions All modeled two-dose varicella vaccination strategies are projected to lead to substantial reductions in varicella disease and to be cost saving compared to no vaccination in Norway.

scholarly journals 1389. Economic Evaluation of Universal Varicella Vaccination in Mexico

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S704-S704
Author(s):  
Enrique Chacon-Cruz ◽  
Estelle Meroc ◽  
Sue Ann Costa-Clemens ◽  
Thomas Verstraeten
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Economic Burden ◽  
Disease Burden ◽  
Varicella Vaccine ◽  
Cost Effective ◽  
Varicella Vaccination ◽  
Published Data ◽  
Vaccination Strategies ◽  
The Impact

Abstract Background Universal varicella vaccination (UVV) has proven to be cost-effective in countries where implemented. However, this has not yet been evaluated for Mexico. We assessed the cost-effectiveness of UVV in the Mexican Immunization Program from both healthcare and societal perspectives. Methods The annual disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) were derived from Mexican seroprevalence-published data adjusted to the 2020 country’s population. The annual economic burden was calculated by combining disease with Mexican published unit cost data. Four different vaccination strategies were evaluated: 1. One dose of a single varicella vaccine at 1 year old; 2. Two doses of single varicella vaccine at 1 and 6 years; 3. One dose of a single varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine (MMRV) at 6 years; 4. Two doses of MMRV at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. The impact of vaccination (number of avoided cases/deaths) was evaluated for a 20 years follow-up period based on vaccine effectiveness (87% and 97.4%), and assuming a 95% coverage. Subsequently, we estimated net vaccination costs, benefit-cost ratio (BCR), annual costs saved, cost-effectiveness ratio. Results From annual disease burden estimation, avoided cases with one dose, and two doses were of 20,570,722 and 23,029,751, respectively. From the 20 years cohort, the yearly number of varicella cases was estimated at 2,041,296, and total costs at $115,565,315 (USD) (healthcare perspective) and $165,372,061 (healthcare and societal perspectives). Strategies 1 and 2 were found to be cost-saving (BCR >1) (Figure 1), and strategy 3 to be cost-effective (CE) ($1539 per Life Year Gained). Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 million and $34.41 million, respectively, to the Mexican society. FIGURE 1 Conclusion 1.The disease and economic burden of varicella in Mexico are high. 2.UVV with four different vaccination strategies results in a high reduction of cases. 3.From healthcare and societal perspectives, UVV was shown to be cost-effective (with strategy 3), and cost-saving (with strategies using one dose or two doses separately). Disclosures All Authors: No reported disclosures

scholarly journals Impact and cost-effectiveness of nonavalent human papillomavirus vaccination in Switzerland: insights from a dynamic transmission model

2019 ◽  
Author(s):  
Maurane Riesen ◽  
Johannes A. Bogaards ◽  
Nicola Low ◽  
Christian L. Althaus
Keyword(s):  
Cervical Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Hpv Vaccination ◽  
Quadrivalent Vaccine ◽  
Transmission Model ◽  
Price Difference ◽  
Dynamic Transmission Model ◽  
Hpv Types ◽  
The Impact

ABSTRACTAIMIn Switzerland, human papillomavirus (HPV) vaccination has been implemented using a quadrivalent vaccine that covers HPV types 16 and 18, responsible for about 70% of cervical cancer. The average national uptake was 56% in girls by the age of 16 years in 2014–2016. A nonavalent vaccine, covering five additional oncogenic HPV types was recommended at the end of 2018. The primary aim of this study was to assess the impact and cost-effectiveness of introducing the nonavalent HPV vaccine in Switzerland compared with the quadrivalent vaccine.METHODSWe developed a dynamic transmission model that describes the spread of 10 high risk HPV types. We informed the model with Swiss data about sexual behaviour and cervical cancer screening, and calibrated the model to cervical cancer incidence in Switzerland. We modelled the impact of quadrivalent and nonavalent vaccines at the achieved (56%) and national recommended uptake (80%) in girls. We calculated the incremental cost-effectiveness ratio (ICER) between the nonavalent vaccine, the quadrivalent vaccine and no vaccination. We evaluated costs linked to cervical cancer screening, treatment of different disease stages and vaccination in a sensitivity analysis.RESULTSCompared with quadrivalent HPV vaccination in Switzerland at 56% uptake, vaccinating with the nonavalent vaccine would avert 1,175 cervical cancer deaths, 3,641 cases of cervical cancer and 106,898 CIN treatments over 100 years at 56% uptake. Compared with the quadrivalent vaccine, which would prevent an estimated 67% and 72% of cervical cancer cases at 56% and 80% coverage, the nonavalent vaccine would prevent 83% and 89% of all cervical cancers at the same coverage rates. The sensitivity analysis shows that introducing the nonavalent vaccination should improve health outcomes and offers a cost-saving alternative to the quadrivalent vaccine under the current price difference.CONCLUSIONSAll scenarios with quadrivalent and nonavalent vaccination are likely to be cost-effective compared with no vaccination. Switching to the nonavalent vaccine at current and improved vaccination uptake is likely to be cost-saving under the investigated price difference.

scholarly journals Vaccination strategies to control Ebola epidemics in the context of variable household inaccessibility levels

2019 ◽  
Author(s):  
G. Chowell ◽  
A. Tariq ◽  
M. Kiskowski
Keyword(s):  
Vaccination Strategy ◽  
Qualitative Change ◽  
Health Interventions ◽  
Transmission Model ◽  
Individual Level ◽  
Vaccination Strategies ◽  
Ring Vaccination ◽  
Low Levels ◽  
The Impact ◽  
Close Contacts

AbstractDespite a very effective vaccine, active conflict and community distrust during the ongoing DRC Ebola epidemic are undermining control efforts, including a ring vaccination strategy that requires the prompt immunization of close contacts of infected individuals. However, in April 2019, it was reported 20% or more of close contacts cannot be reached or refuse vaccination [1], and it is predicted that the ring vaccination strategy would not be effective with such a high level of inaccessibility [2]. The vaccination strategy is now incorporating a “third ring” community-level vaccination that targets members of communities even if they are not known contacts of Ebola cases. To assess the impact of vaccination strategies for controlling Ebola epidemics in the context of variable levels of community accessibility, we employed an individual-level stochastic transmission model that incorporates four sources of heterogeneity: a proportion of the population is inaccessible for contact tracing and vaccination due to lack of confidence in interventions or geographic inaccessibility, two levels of population mixing resembling household and community transmission, two types of vaccine doses with different time periods until immunity, and transmission rates that depend on spatial distance. Our results indicate that a ring vaccination strategy alone would not be effective for containing the epidemic in the context of significant delays to vaccinating contacts even for low levels of household inaccessibility and affirm the positive impact of a supplemental community vaccination strategy. Our key results are that as levels of inaccessibility increase, there is a qualitative change in the effectiveness of the vaccination strategy. For higher levels of vaccine access, the probability that the epidemic will end steadily increases over time, even if probabilities are lower than they would be otherwise with full community participation. For levels of vaccine access that are too low, however, the vaccination strategies are not expected to be successful in ending the epidemic even though they help lower incidence levels, which saves lives, and makes the epidemic easier to contain and reduces spread to other communities. This qualitative change occurs for both types of vaccination strategies: ring vaccination is effective for containing an outbreak until the levels of inaccessibility exceeds approximately 10% in the context of significant delays to vaccinating contacts, a combined ring and community vaccination strategy is effective until the levels of inaccessibility exceeds approximately 50%. More broadly, our results underscore the need to enhance community engagement to public health interventions in order to enhance the effectiveness of control interventions to ensure outbreak containment.Author summaryIn the context of the ongoing Ebola epidemic in DRC, active conflict and community distrust are undermining control efforts, including vaccination strategies. In this paper, we employed an individual-level stochastic structured transmission model to assess the impact of vaccination strategies on epidemic control in the context of variable levels of household inaccessibility. We found that a ring vaccination strategy of close contacts would not be effective for containing the epidemic in the context of significant delays to vaccinating contacts even for low levels of household inaccessibility and evaluate the impact of a supplemental community vaccination strategy. For lower levels of inaccessibility, the probability of epidemic containment increases over time. For higher levels of inaccessibility, even the combined ring and community vaccination strategies are not expected to contain the epidemic even though they help lower incidence levels, which saves lives, makes the epidemic easier to contain and reduces spread to other communities. We found that ring vaccination is effective for containing an outbreak until the levels of inaccessibility exceeds approximately 10%, a combined ring and community vaccination strategy is effective until the levels of inaccessibility exceeds approximately 50%. Our findings underscore the need to enhance community engagement to public health interventions.

scholarly journals Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years

2009 ◽  
Vol 14 (35) ◽  
Author(s):  
G Giammanco ◽  
S Ciriminna ◽  
I Barberi ◽  
L Titone ◽  
M Lo Giudice ◽  
...  
Keyword(s):  
Vaccination Programme ◽  
Vaccine Coverage ◽  
Varicella Vaccine ◽  
Age Groups ◽  
Vaccination Strategy ◽  
Paediatric Population ◽  
Incidence Rates ◽  
Universal Vaccination ◽  
Varicella Vaccination ◽  
Local Health

Following the licensure of the Oka/Merck varicella vaccine in Italy in January 2003, the Sicilian health authorities launched a universal vaccination programme in all nine Local Health Units. A two-cohort vaccination strategy was adopted to minimise the shift of the mean age of varicella occurrence to older age groups, with the goal of vaccinating with one dose at least 80% of children in their second year of life and 50% of susceptible adolescents in their 12th year of life. Two studies were implemented in parallel to closely monitor vaccination coverage as well as varicella incidence. Overall, the programme achieved its target, with 87.5% vaccine coverage for the birth cohort 2005 and 90.2% for adolescents born in 1995 and 1996. Varicella surveillance data obtained from a total of 28,188 children (0-14 years-old) monitored by family paediatricians showed a decline in incidence rates from 95.7 (95% confidence interval (CI): 72.2-126.8) for 1,000 person-years (PY) in 2004 to 9.0 (95% CI: 6.4-12.6) for 1,000 PY in 2007. In Europe, the only similar experience is the routine childhood varicella vaccination programme in Germany that started in 2004 with a single dose at the age of 11-14 months. The two-cohort universal vaccination programme implemented in Sicily, as well as the network for the surveillance study, can offer a model to other European countries that are considering introducing universal childhood varicella vaccination.

scholarly journals A Centralized Outbreak of Varicella among Children Attending Preschool in Suzhou, China

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Min Zhang ◽  
Guo-Ping Gui ◽  
Feng Guo ◽  
Xin-Fang Fan ◽  
Ri-Sheng Zha
Keyword(s):  
Risk Factors ◽  
Single Dose ◽  
Varicella Vaccine ◽  
Vaccination Strategy ◽  
Vaccination Status ◽  
Varicella Vaccination ◽  
Key Factors ◽  
Vaccine Failure ◽  
Information Platform ◽  
History Of

Background. Varicella vaccine is available for voluntary purchase with a single dose currently recommended for children aged ≥12 months. An epidemiological study was undertaken in order to determine the characteristics of the outbreak, assess vaccine effectiveness, and examine risk factors for vaccine failure. Methods. A varicella case was defined as a generalized papulovesicular rash (without other apparent causes) in a child without prior varicella attending the kindergarten during February 22 to April 7 of 2016. Varicella among vaccinated children (breakthrough varicella) was defined as varicella occurring >42 days after vaccination. Children’s vaccination status was verified with immunization records through local vaccination information platform. Results. Of the 738 children, 664 (90.0%) had no prior varicella history. Of these, 364 (54.8%) had received a single-dose varicella vaccine before outbreak. A total of 30 cases occurred in the outbreak, and 9 of them (30%) had breakthrough varicella. Age at vaccination (<15 months vs. ≥15 months) and time since vaccination before the outbreak (<3 years vs. ≥3 years) were not related to the occurrence of breakthrough varicella (P>0.05). Single-dose varicella vaccination was 64.7% effective in preventing any varicella. Conclusions. Single-dose varicella vaccine is effective in reducing the varicella attack rate, but not high enough to prevent outbreak. Timely detection and effective isolation are key factors in controlling varicella. Improving single-dose vaccination coverage and implementing two-dose vaccination strategy should be recommended to provide excellent protection to prevent varicella in the future in Suzhou.

scholarly journals Cost-effectiveness of rivaroxaban compared with enoxaparin plus warfarin for the treatment of hospitalised acute deep vein thrombosis in China

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038433
Author(s):  
Li Yang ◽  
Jingjing Wu
Keyword(s):  
Deep Vein Thrombosis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Transition Probabilities ◽  
Sensitivity Analyses ◽  
Vein Thrombosis ◽  
Life Years ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein ◽  
The Impact

ObjectiveLimited economic evaluation data for rivaroxaban compared with standard of care (SoC) exists in China. The objective of this analysis was to evaluate the cost-effectiveness of rivaroxaban compared with current SoC (enoxaparin overlapped with warfarin) for the treatment of acute deep vein thrombosis (DVT) in China.MethodsA Markov model was adapted from a payer’s perspective to evaluate the costs and quality-adjusted life years (QALYs) of patients with DVT treated with rivaroxaban or enoxaparin/warfarin. Clinical data from the EINSTEIN-DVT trial were obtained to estimate the transition probabilities. Data on Chinese health resource use, unit costs and utility parameters were collected from previously published literature and used to estimate the total costs and QALYs. The time horizon was set at 5 years and a 3-month cycle length was used in the model. A 5% discount rate was applied to the projected costs. One-way sensitivity analyses and probabilistic sensitivity analyses were undertaken to assess the impact of uncertainty on results.ResultsRivaroxaban therapy resulted in an increase of 0.008 QALYs and was associated with lower total costs compared with enoxaparin/warfarin (US$4744.4 vs US$5572.4, respectively), demonstrating it to be a cost-saving treatment strategy. The results were mainly sensitive to length of hospitalisation due to DVT on enoxaparin/warfarin, cost per day of hospitalisation and the difference in length of stay of rivaroxaban-treated and enoxaparin/warfarin-treated patients.ConclusionRivaroxaban therapy resulted in a cost saving compared with enoxaparin/warfarin for the anticoagulation treatment of patients with hospitalised acute DVT in China.Trial registration numberNCT00440193; Post-results.

Modelling the impact of varicella vaccination on varicella and zoster

2009 ◽  
Vol 138 (4) ◽  
pp. 469-481 ◽  
Author(s):  
M. KARHUNEN ◽  
T. LEINO ◽  
H. SALO ◽  
I. DAVIDKIN ◽  
T. KILPI ◽  
...  
Keyword(s):  
Large Scale ◽  
Vaccine Coverage ◽  
Varicella Vaccine ◽  
Age Groups ◽  
Varicella Vaccination ◽  
Negative Consequences ◽  
Serological Data ◽  
Notification Data ◽  
The Impact ◽  
Case Notification

SUMMARYIt has been suggested that the incidence of herpes zoster may increase due to lack of natural boosting under large-scale vaccination with the varicella vaccine. To study the possibility and magnitude of such negative consequences of mass vaccination, we built a mathematical model of varicella and zoster epidemiology in the Finnish population. The model was based on serological data on varicella infection, case-notification data on zoster, and new knowledge about close contacts relevant to transmission of infection. According to the analysis, a childhood programme against varicella will increase the incidence of zoster by one to more than two thirds in the next 50 years. This will be due to increase in case numbers in the ⩾35 years age groups. However, high vaccine coverage and a two-dose programme will be very effective in stopping varicella transmission in the population.

scholarly journals Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 344
Author(s):  
Silvia Cocchio ◽  
Tolinda Gallo ◽  
Stefania Del Zotto ◽  
Elena Clagnan ◽  
Andrea Iob ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Vaccination Strategy ◽  
The Elderly ◽  
Protective Role ◽  
The Body ◽  
Health Concern ◽  
Respiratory Complications ◽  
Effective Prevention ◽  
Vaccination Strategies ◽  
The Impact

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016–2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R2 = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59–0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70–0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59–0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly.

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