Cost-effectiveness of varicella serotesting versus presumptive vaccination of school-age children and adolescents.
OBJECTIVE
To evaluate the cost-effectiveness of presumptive vaccination versus serological testing of school-age children (6 to 12 years) and adolescents (13 to 17 years) with a negative or uncertain history of varicella.


METHODS
Decision analysis model based on published and unpublished probabilities and costs.


METHODS
Hypothetical cohorts of 10,000 school-age children and 10,000 adolescents.


METHODS
Number of chicken pox cases prevented and cost per chicken pox case prevented.


RESULTS
For school-age children, presumptively vaccinating would prevent 95% of the predicted chicken pox cases, would result in net savings when long-term and work loss costs were included, and would have a similar cost per case prevented as routinely testing before vaccination. For adolescents, presumptively vaccinating would be the most effective policy, and would prevent 99% of the projected chicken pox cases. A policy of routinely testing before vaccination would be the least effective policy for adolescents, preventing 81% of the predicted cases. However, even when long-term and work loss costs were taken into account, presumptively vaccinating adolescents had a relatively high cost of $329 per chicken pox case prevented and extremely high incremental costs per chicken pox case prevented compared with policies that involved serological testing. Results for school-age children were sensitive to the probability of previously having had chicken pox given a negative or uncertain history, to the rate of adherence to follow-up visits, and to vaccine price and test price. Results for adolescents were sensitive only to the rate of adherence to the first follow-up visit.


CONCLUSIONS
Presumptively vaccinating all patients with a negative or uncertain history of varicella is projected to be a relatively cost-effective policy for school-age children but not for adolescents. However, further empirical studies of the accuracy of a negative or uncertain history of chicken pox in these age groups are needed.
Lieu
T A
TA
Division of Research, Permanente Medical Group, Oakland, CA 94611, USA.
Finkler
L J
LJ
Sorel
M E
ME
Black
S B
SB
Shinefield
H R
HR
D000293:Adolescent; D002644:Chickenpox / Q000175:diagnosis / Q000517:prevention & control*; D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D012698:Serologic Tests / Q000191:economics*; D014481:United States; D014611:Vaccination / Q000191:economics*