title: Childhood varicella-zoster virus vaccination in Belgium: cost-effective only in the long run or without exogenous boosting?
abstract: OBJECTIVE
  To assess the effectiveness and cost-effectiveness of a universal childhood varicella-zoster vaccination programme in Belgium (1) using the most recent Belgian data on varicella-zoster burden, (2) exploring different options for the timing of the second dose, (3) obtaining results with and without exogenous natural boosting, and (4) investigating the possible additional benefit of zoster booster vaccination for adults at age 50 or 60 y.
  
  
  METHODS
  An extensively studied and improved dynamic model is used to estimate primary and breakthrough chickenpox and zoster cases over time. For a range of vaccination options, we compared the direct costs (health care payer perspective) and health outcomes (including Quality-Adjusted Life-Years (QALYs) lost) associated with chickenpox and herpes zoster. Estimates of social contact patterns, health care use, costs and QALY losses are almost exclusively based on Belgian databases and surveys.
  
  
  CONCLUSIONS
  If exogenous natural boosting exists, a net loss in QALYs is expected for several decades after implementing a universal chickenpox vaccination programme, due to an increase in zoster mainly in persons aged 50-80 y. This result holds also for scenarios that minimise or counteract the expected increase in zoster incidence (e.g. additional booster vaccinations in adults). However, if the boosting hypothesis is not true or if costs and QALYs are cumulated over at least 33 to more than 100 y after vaccination (depending on the assumptions made), different options for universal 2-dose vaccination against chickenpox in Belgium would be cost-effective at a vaccine price of €43/dose or lower.
authors: Center for Health Economic Research and Modeling Infectious Diseases (CHERMID); Vaccine and Infectious Disease Institute (Vaxinfectio); University of Antwerp; Wilrijk, Belgium.
authors: Joke
authors: J
authors: Bilcke
authors: Albert Jan
authors: AJ
authors: van Hoek
authors: Philippe
authors: P
authors: Beutels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D002644:Chickenpox / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006562:Herpes Zoster / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000191:economics / Q000379:methods*; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine
keywords: Zostavax; age; chickenpox; cost-utility; shingles; time horizon; uncertainty