title: Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster.
abstract: BACKGROUND
  Varicella zoster virus (VZV) is the etiological agent of varicella and herpes zoster (HZ). It has been hypothesised that immune boosting of latently infected persons by contact with varicella reduces the probability of HZ. If true, universal varicella vaccination may increase HZ incidence due to reduced VZV circulation. To inform decision-making, we conduct cost-effectiveness analyses of varicella vaccination, including effects on HZ.
  
  
  METHODS
  Effects of varicella vaccination are simulated with a dynamic transmission model, parameterised with Dutch VZV seroprevalence and HZ incidence data, and linked to an economic model. We consider vaccination scenarios that differ by whether or not they include immune boosting, and reactivation of vaccine virus.
  
  
  RESULTS
  Varicella incidence decreases after introduction of vaccination, while HZ incidence may increase or decrease depending on whether or not immune boosting is present. Without immune boosting, vaccination is expected to be cost-effective or even cost-saving. With immune boosting, vaccination at 95% coverage is not expected to be cost-effective, and may even cause net health losses.
  
  
  CONCLUSIONS
  Cost-effectiveness of varicella vaccination depends strongly on the impact on HZ and the economic time horizon. Our findings reveal ethical dilemmas as varicella vaccination may result in unequal distribution of health effects between generations.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Alies
authors.initials: A
authors.lastname: van Lier
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Lugnér
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Opstelten
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Jochemsen
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Jacco
authors.initials: J
authors.lastname: Wallinga
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands ; Department of General Practice & Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, v/d Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
authors.forename: François
authors.initials: F
authors.lastname: Schellevis
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands ; Department of Paediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sanders
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Hester
authors.initials: H
authors.lastname: de Melker
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: van Boven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002644:Chickenpox / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D019433:Chickenpox Vaccine / Q000009:adverse effects / Q000191:economics* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine
keywords: Cost-effectiveness; Transmission model; Vaccination; Varicella zoster virus