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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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Autores principales: van Lier, Alies, Lugnér, Anna, Opstelten, Wim, Jochemsen, Petra, Wallinga, Jacco, Schellevis, François, Sanders, Elisabeth, de Melker, Hester, van Boven, Michiel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634630/
https://www.ncbi.nlm.nih.gov/pubmed/26629544
http://dx.doi.org/10.1016/j.ebiom.2015.08.017
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author van Lier, Alies
Lugnér, Anna
Opstelten, Wim
Jochemsen, Petra
Wallinga, Jacco
Schellevis, François
Sanders, Elisabeth
de Melker, Hester
van Boven, Michiel
author_facet van Lier, Alies
Lugnér, Anna
Opstelten, Wim
Jochemsen, Petra
Wallinga, Jacco
Schellevis, François
Sanders, Elisabeth
de Melker, Hester
van Boven, Michiel
author_sort van Lier, Alies
collection PubMed
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.
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spelling pubmed-46346302015-12-01 Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster van Lier, Alies Lugnér, Anna Opstelten, Wim Jochemsen, Petra Wallinga, Jacco Schellevis, François Sanders, Elisabeth de Melker, Hester van Boven, Michiel EBioMedicine Research Article 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. Elsevier 2015-08-08 /pmc/articles/PMC4634630/ /pubmed/26629544 http://dx.doi.org/10.1016/j.ebiom.2015.08.017 Text en © 2015 The Authors. Published by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
van Lier, Alies
Lugnér, Anna
Opstelten, Wim
Jochemsen, Petra
Wallinga, Jacco
Schellevis, François
Sanders, Elisabeth
de Melker, Hester
van Boven, Michiel
Distribution of Health Effects and Cost-effectiveness of Varicella Vaccination are Shaped by the Impact on Herpes Zoster
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 Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634630/
https://www.ncbi.nlm.nih.gov/pubmed/26629544
http://dx.doi.org/10.1016/j.ebiom.2015.08.017
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