Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model

Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. National vaccination programme in Sweden,...

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Bibliographic Details
Published in:PloS one 2021-05, Vol.16 (5), p.e0251644-e0251644
Main Authors: Wolff, Ellen, Widgren, Katarina, Scalia Tomba, Gianpaolo, Roth, Adam, Lep, Tiia, Andersson, Sören
Format: Article
Language:English
Subjects:
Age
Age groups
Biology and Life Sciences
Chicken pox
Chickenpox
Cost analysis
Data analysis
Data management
Disease
Economic aspects
Economic models
Editing
Evaluation
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Health Care Service and Management, Health Policy and Services and Health Economy
Health Sciences
Herpes zoster
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Hälsovetenskap
Infections
Medical and Health Sciences
Medical care, Cost of
Medicin och hälsovetenskap
Medicine
Medicine and Health Sciences
Methodology
Pain
People and places
Population
Prevention
Public health
Public Health, Global Health, Social Medicine and Epidemiology
Shingles (Disease)
Social Sciences
Vaccination
Vaccines
Varicella
Viruses
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Summary:Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. Hypothetical cohorts of people aged 12 months and 65-years at baseline. Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective-the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0251644