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Article
February 2, 1994

Cost-effectiveness of a Routine Varicella Vaccination Program for US Children

Author Affiliations

From the Robert Wood Johnson Clinical Scholars Program and Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco (Dr Lieu); Division of Research, The Permanente Medical Group, Oakland, Calif (Dr Lieu); Surveillance, Investigations, and Research Branch, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Cochi, Holmes, and Wharton); Kaiser Permanente Pediatric Vaccine Study Center, Oakland, Calif (Drs Black and Shinefield); Division of Biostatistics, Emory University School of Public Health, Atlanta, Ga (Dr Halloran); and MEDTEP Research Center on Minority Populations, Institute for Health Policy Studies, and Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco (Dr Washington).

JAMA. 1994;271(5):375-381. doi:10.1001/jama.1994.03510290057037
Abstract

Objective.  —To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children.

Methods.  —Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database.

Results.  —A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%.

Conclusions.  —A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.(JAMA. 1994;271:375-381)

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