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Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model

Author

Listed:
  • Lara J Wolfson
  • Vincent J Daniels
  • Matthew Pillsbury
  • Zafer Kurugöl
  • Cuneyt Yardimci
  • Jeffrey Kyle
  • Ener Cagri Dinleyici

Abstract

Background: In 2013, Turkey introduced one-dose universal varicella vaccination (UVV) at 12 months of age. Inclusion of a second dose is being considered. Methods: We developed a dynamic transmission model to evaluate three vaccination strategies: single dose at 12 months (1D) or second dose at either 18 months (2D-short) or 6 years of age (2D-long). Costs and utilization were age-stratified and separated into inpatient and outpatient costs for varicella and herpes zoster (HZ). We ran the model including and excluding HZ-related costs and impact of exogenous boosting. Results: Five years post-introduction of UVV (1D), the projected varicella incidence rate decreases from 1,674 cases pre-vaccine to 80 cases/100,000 person-years. By 25 years, varicella incidence equilibrates at 39, 12, and 16 cases/100,000 person-years for 1D, 2D-short, and 2D-long strategies, respectively, using a highly effective vaccine. With or without including exogenous boosting impact and/or HZ-related costs and health benefits, the 1D strategy is least costly, but 2-dose strategies are cost-effective considering a willingness-to-pay threshold equivalent to the gross domestic product. The model predicted a modest increase in HZ burden during the first 20–30 years, after which time HZ incidence equilibrates at a lower rate than pre-vaccine. Conclusions: Our findings support adding a second varicella vaccine dose in Turkey, as doing so is highly cost-effective across a wide range of assumptions regarding the burden associated with varicella and HZ disease.

Suggested Citation

  • Lara J Wolfson & Vincent J Daniels & Matthew Pillsbury & Zafer Kurugöl & Cuneyt Yardimci & Jeffrey Kyle & Ener Cagri Dinleyici, 2019. "Cost-effectiveness analysis of universal varicella vaccination in Turkey using a dynamic transmission model," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-26, August.
    • Handle: RePEc:plo:pone00:0220921
    DOI: 10.1371/journal.pone.0220921
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Alp, Handan & Altinkaynak, Sevin & Ertekin, Vildan & Kilicaslan, Buket & Giiraksin, Asuman, 2005. "Seroepidemiology of varicella-zoster virus infection in a cosmopolitan city (Erzurum) in the eastern Turkey," Health Policy, Elsevier, vol. 72(1), pages 119-124, April.
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    1. Manjiri Pawaskar & Colleen Burgess & Mathew Pillsbury & Torbjørn Wisløff & Elmira Flem, 2021. "Clinical and economic impact of universal varicella vaccination in Norway: A modeling study," PLOS ONE, Public Library of Science, vol. 16(7), pages 1-14, July.

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