title: Economic burden of varicella in Singapore--a cost benefit estimate of implementation of a routine varicella vaccination.
abstract: Varicella is a common childhood illness that can result in significant morbidity and mortality. As early as 1995, recommendations for routine varicella vaccination have been published, but have not been universally implemented, with cost of vaccination as a major reason. Though available from 1996, the vaccine has yet to be routinely implemented in Singapore. We set out to assess the economic burden of varicella and the cost-benefit of adding a varicella vaccine to the existing immunization schedule in Singapore. In this study, using data from 1994--1995 the direct cost estimates were based on all levels of medical care; inpatient care, emergency room visits, primary health care and medication. Indirect costs were estimated from the cost of time lost by patients and their families attending to medical needs, as well as loss of productivity due to absenteeism. The cost of a vaccination program targeted at 15-month old infants receiving concomitant measles-mumps-rubella immunization was also assessed. The cost-benefit ratio was then estimated. The total cost of varicella in Singapore was estimated to be US$11.8 million per annum. The loss of productivity accounted for a large proportion of the total cost as a lot of parents took leave when their children were ill. The estimates of total cost represent approximately US$188 per varicella case per year. In comparison, the cost of a vaccination program was found to be US$3.3 million per annum. The cost per case averted was US$104. From a societal point of view, for every dollar invested in a vaccination program, we would save about US$2 dollars.
authors.affiliation: Department of Pediatrics, National University of Singapore, Singapore.
authors.forename: Lee M L
authors.initials: LM
authors.lastname: Jean-Jasmin
authors.forename: Shek Pei-chi
authors.initials: SP
authors.lastname: Lynette
authors.forename: Ma
authors.initials: M
authors.lastname: Stefan
authors.forename: Chew Suok
authors.initials: CS
authors.lastname: Kai
authors.forename: F T
authors.initials: FT
authors.lastname: Chew
authors.forename: Lee Bee
authors.initials: LB
authors.lastname: Wah
mesh_terms: D000212:Acyclovir / Q000191:economics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D002644:Chickenpox / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000191:economics*; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004526:Efficiency; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000191:economics; D009819:Office Visits / Q000191:economics; D012846:Singapore / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D019433:Chickenpox Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D000212:Acyclovir