[Cost-effectiveness of varicella vaccination in Spanish adolescents].
BACKGROUND
Varicella is a highly contagious disease. In Spain, in 1996, 91% of the population aged 13 years old had been infected. The complications of varicella are more frequent in adults. Herpes zoster infection can be reactivated after the initial infection in 15%. A vaccine against varicella has recently been authorized in Spain for use in individuals aged more than 13 years old with negative serology.


OBJECTIVE
To determine the cost-effectiveness of vaccination of the cohort aged 13 years old in 2001 and to perform a sensitivity analysis of the parameters that are affected.


METHODS
Tree decision: Decision Analysis by Tree-Age program. Probabilities and costs were calculated using Microsoft Excel. Population size was obtained from the 2001 Census of the National Institute of Statistics to which we applied the percentage of susceptibility from the seroepidemiological study in Spain. Probabilities were calculated by the Bayes Theorem, using the incidence rates by age of a country in the northern hemisphere. Hospital-related data were obtained from the minimum data set. We used the effectiveness of the vaccine licensed in the USA, with a total effectiveness of 71% and a partial effectiveness of 24%, represented by milder varicella in vaccinated individuals (breakthrough varicella). Only direct costs were considered. Costs were obtained by direct consultation of different sources. A discount rate of 3% was used.


RESULTS
Varicella vaccination could prevent 27,278 cases of the disease. Prevention of one case would cost the public health system 131 Euros.


CONCLUSIONS
This study constitutes an approach to the cost of introducing varicella vaccination in the Spanish vaccination schedule, from the payer's perspective. However, to take a decision, some unknown factors, such as the effect of vaccination on the incidence of herpes zoster, should be assessed. With currently available data, the introduction of vaccination in adolescence would seem to be the best strategy, but further studies are needed.
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. sabela@isciii.es
Isabel
I
Peña-Rey
Napoleón
N
Pérez-Farinós
Marta
M
Cortés-García
Carmen
C
Amela-Heras
D000293:Adolescent; D002644:Chickenpox / Q000191:economics* / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D013030:Spain
D019433:Chickenpox Vaccine