Economic Evaluation of Varicella Vaccination with Probabilistic Approach: Consideration of Varicella and Herpes Zoster Infection
Date Issued
2006
Date
2006
Author(s)
Chang, I-Jing
DOI
en-US
Abstract
Abstract
Introduction
Although the efficacy of varicella vaccination has been demonstrated, it is still unclear whether there is a long-term benefit after universal vaccination, which has been argued with lacking of boosting leading to weak immunity and the severe disease due to the delay age. The failure of reaching consensus may be also involved in costs implicated from different viewpoints. Very few studies on economic evaluation have been conducted to address these issues based on different perspective and taken the joint uncertainty of parameters.
Objectives
We aimed at constructing the transmission model of varicella zoster virus infection to perform an economic evaluation for varicella vaccination at age of 12 month old, considering the long-term impact on herpes zoster in Taiwan, from health care payer’s perspective, consumer’s and the societal perspective.
Methods
An analytic-decision Markov model was developed to model the disease natural history of varicella and herpes zoster infection together with the sequalae of two infections in the absence of vaccination. By the application of the vaccine efficacy from literature review, willingness to pay from empirical survey, and the incorporation of direct and indirect cost, a decision on universal vaccination, was compared with no vaccination by three types of formal economic evaluation, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis, given different perspectives. Both deterministic and probabilistic approaches were used to estimate incremental cost-effectiveness ratios, incremental cost-utility ratio, benefit-cost ratio, and net benefit.
Results
The simulated results found the uptake of vaccination program may not only lead to 76% and 72% reduction of varicella cases and herpes zoster, respectively, but also averted 71%-90% complications or deaths pertaining to varicella and herpes zoster.
By using deterministic approach, the incremental cost ratio in cost-effectiveness analysis, vaccination was dominant over no vaccination from both healthcare payer’s and societal perspectives. From both perspectives, dominant results were obtained using probabilistic approach. Negative estimates from both healthcare payer’s and societal perspectives indicated the dominance of vaccination over no vaccination.
In cost-benefit analysis, using a deterministic approach, a NTD 1.17 of benefit/cost ratio was estimated, suggesting a 0.17 more dollars returned benefit per dollar invested in vaccination if we take healthcare payer’s perspective. Given societal perspective, the benefit/cost ratio was increased to NTD 1.76, amounting to have NTD 1 invested in vaccination in return for approximately NTD 2.
The results of estimating the absolute net benefit based on willingness to pay showed given health care perspective, there was a total of NTD 185,600,000 net balance between net cost and net benefit from health perspective. A larger benefit was seen from societal perspective. By the application of a probabilistic approach, we produced the mean value of NTD 185,600,000 (95% CI: NTD 170,000,000- NTD 200,000,000) with a range between NTD 170,000,000 and NTD 200,000,000. A large benefit was also seen when societal perspective was taken.
Conclusion
Using a formal economic evaluation making allowance for both short-term and long-term outcome, we concluded Universal vaccination seem both cost-effective and cost-beneficial if healthcare payer, societal, and consumer viewpoint were held, favoring the policy of varicella zoster virus vaccination at infancy.
Subjects
水痘疫苗
帶狀疱
疹
水痘
Varicella vaccine
herpes zoster
varicella
SDGs
Type
thesis
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