title: Cost-effectiveness of routine varicella vaccination using the measles, mumps, rubella and varicella vaccine in France: an economic analysis based on a dynamic transmission model for varicella and herpes zoster.
abstract: OBJECTIVE
  Each year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs.
  
  
  METHODS
  Based on the outputs of a dynamic transmission model that used data on epidemiology and costs from France, a cost-effectiveness model was built. A conservative approach was taken regarding the impact of varicella vaccination on zoster incidence by assuming the validity of the hypothesis of an age-specific boosting of immunity against varicella.
  
  
  RESULTS
  The model determined that routine MMRV vaccination is expected to be a cost-effective option, considering a cost-effectiveness threshold of €20,000 per quality-adjusted life-year saved; routine vaccination was cost-saving from the societal perspective. Results were driven by a large decrease in varicella incidence despite a temporary initial increase in the number of zoster cases due to the assumption of exogenous boosting. In the scenario analyses, despite moderate changes in assumptions about incidence and costs, varicella vaccination remained a cost-effective option for France.
  
  
  CONCLUSIONS
  Routine vaccination with MMRV was associated with high gains in quality-adjusted life-years, substantial reduction in the occurrences of varicella- and zoster-related complications, and few deaths due to varicella. Routine MMRV vaccination is also expected to provide reductions in costs related to hospitalizations, medication use, and general-practitioner visits, as well as indirect costs, and it is expected to be a cost-effective intervention in France (GSK study identifier: HO-12-6924).
authors.affiliation: Mapi Consultancy, Houten, the Netherlands.
authors.forename: Kavi J
authors.initials: KJ
authors.lastname: Littlewood
authors.affiliation: Mapi Consultancy, Houten, the Netherlands.
authors.forename: Mario J N M
authors.initials: MJ
authors.lastname: Ouwens
authors.affiliation: Health Economics, GSK Vaccines, Wavre, Belgium. Electronic address: christophe.j.sauboin@gsk.com.
authors.forename: Christophe
authors.initials: C
authors.lastname: Sauboin
authors.affiliation: Pharmaco Epidemiology Unit, GSK France, Marly-le-Roi, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tehard
authors.affiliation: University of Limoges, Faculty of Medicine, Bacteriology-Virology Service, Limoges, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Alain
authors.affiliation: CHU of Limoges, Bacteriology-Virology Hygiene Service, Limoges, France.
authors.forename: François
authors.initials: F
authors.lastname: Denis
mesh_terms: D000367:Age Factors; D002644:Chickenpox / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D005602:France; D006562:Herpes Zoster / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage* / Q000191:economics; D019057:Quality-Adjusted Life Years; D014611:Vaccination / Q000191:economics*; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000191:economics
chemical_list: D019433:Chickenpox Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D017778:Vaccines, Combined; C050102:measles, mumps, rubella, varicella vaccine
keywords: France; dynamic model; economic analysis; vaccination; varicella; zoster