Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster
Introduction: 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 incide...
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| Format: | Article |
| Language: | English |
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Elsevier
2015-10-01
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| Series: | EBioMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396415301092 |
| _version_ | 1819172273543708672 |
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| author | Alies van Lier Anna Lugnér Wim Opstelten Petra Jochemsen Jacco Wallinga François Schellevis Elisabeth Sanders Hester de Melker Michiel van Boven |
| author_facet | Alies van Lier Anna Lugnér Wim Opstelten Petra Jochemsen Jacco Wallinga François Schellevis Elisabeth Sanders Hester de Melker Michiel van Boven |
| author_sort | Alies van Lier |
| collection | DOAJ |
| description | Introduction: 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. |
| first_indexed | 2024-12-22T20:04:34Z |
| format | Article |
| id | doaj.art-4a9dc27ebcd94ca68c3cbc6caa40acc7 |
| institution | Directory Open Access Journal |
| issn | 2352-3964 |
| language | English |
| last_indexed | 2024-12-22T20:04:34Z |
| publishDate | 2015-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EBioMedicine |
| spelling | doaj.art-4a9dc27ebcd94ca68c3cbc6caa40acc72022-12-21T18:14:10ZengElsevierEBioMedicine2352-39642015-10-012101494149910.1016/j.ebiom.2015.08.017Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes ZosterAlies van Lier0Anna Lugnér1Wim Opstelten2Petra Jochemsen3Jacco Wallinga4François Schellevis5Elisabeth Sanders6Hester de Melker7Michiel van Boven8Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsNIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsCentre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The NetherlandsIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2352396415301092Varicella zoster virusVaccinationTransmission modelCost-effectiveness |
| spellingShingle | Alies van Lier Anna Lugnér Wim Opstelten Petra Jochemsen Jacco Wallinga François Schellevis Elisabeth Sanders Hester de Melker Michiel van Boven Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster EBioMedicine Varicella zoster virus Vaccination Transmission model Cost-effectiveness |
| title | Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster |
| title_full | Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster |
| title_fullStr | Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster |
| title_full_unstemmed | Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster |
| title_short | Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster |
| title_sort | distribution of health effects and cost effectiveness of varicella vaccination are shaped by the impact on herpes zoster |
| topic | Varicella zoster virus Vaccination Transmission model Cost-effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S2352396415301092 |
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