title: Systematic review of models assessing the economic value of routine varicella and herpes zoster vaccination in high-income countries.
abstract: BACKGROUND
  A systematic review was conducted to assess the cost-effectiveness of routine varicella and herpes zoster (HZ) vaccination in high-income countries estimated by modelling studies.
  
  
  METHODS
  A PubMed search was performed to identify relevant studies published before October 2013. Studies were included in the review if they (i) evaluated the cost-effectiveness of routine childhood or adolescent varicella vaccination and/or HZ vaccination targeting the elderly, and if they (ii) reported results for high-income countries.
  
  
  RESULTS
  A total of 38 model-based studies were identified that fulfilled the inclusion criteria. Routine childhood or adolescent varicella vaccination was cost-effective or cost-saving from a payer perspective and always cost-saving from a societal perspective when ignoring its potential impact on HZ incidence due to reduced or absent exogenous boosting. The inclusion of the potential impact of childhood varicella vaccination on HZ led to net quality-adjusted life-year (QALY) losses or incremental cost-effectiveness ratios exceeding commonly accepted thresholds. Additional HZ vaccination could partially mitigate this effect. Studies focusing only on the evaluation of HZ vaccination reported a wide range of results depending on the selected target age-group and the vaccine price, but most found HZ vaccination to be a cost-effective or marginally cost-effective intervention. Cost-effectiveness of HZ vaccination was strongly dependent on the age at vaccination, the price of the vaccine, the assumed duration of protection and the applied cost per QALY threshold.
  
  
  CONCLUSIONS
  While HZ vaccination is mostly considered cost-effective, cost-effectiveness of varicella vaccination primarily depends on the in- or exclusion of exogenous boosting in the model. As a consequence, clarification on the role of exogenous boosting is crucial for decision-making regarding varicella vaccination.
authors.affiliation: Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany. oliver.damm@uni-bielefeld.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Damm
authors.affiliation: Immunisation Unit, Robert Koch Institute, Berlin, Germany. ultschb@rki.de.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ultsch
authors.affiliation: Helmholtz Centre for Infection Research, Brunswick, Germany. johannes.horn@helmholtz-hzi.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Horn
authors.affiliation: Helmholtz Centre for Infection Research, Brunswick, Germany. rafael.mikolajczyk@helmholtz-hzi.de.|Hannover Medical School, Hannover, Germany. rafael.mikolajczyk@helmholtz-hzi.de.
authors.forename: Rafael T
authors.initials: RT
authors.lastname: Mikolajczyk
authors.affiliation: Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany. wolfgang.greiner@uni-bielefeld.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greiner
authors.affiliation: Immunisation Unit, Robert Koch Institute, Berlin, Germany. wichmanno@rki.de.
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
mesh_terms: D000367:Age Factors; D002644:Chickenpox / Q000453:epidemiology / Q000517:prevention & control*; D019433:Chickenpox Vaccine / Q000008:administration & dosage* / Q000191:economics*; D003132:Commerce; D003362:Cost-Benefit Analysis; D019049:Developed Countries / Q000706:statistics & numerical data*; D006562:Herpes Zoster / Q000453:epidemiology / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D015994:Incidence; D019057:Quality-Adjusted Life Years
chemical_list: D019433:Chickenpox Vaccine; D053061:Herpes Zoster Vaccine