The cost-effectiveness of varicella and combined varicella and herpes zoster vaccination programmes in the United Kingdom
Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, LondonNW9 5EQ, UK. Vaccine
(Impact Factor: 3.62).
11/2011; 30(6):1225-34. DOI: 10.1016/j.vaccine.2011.11.026
Despite the existence of varicella vaccine, many developed countries have not introduced it into their national schedules, partly because of concerns about whether herpes zoster (HZ, shingles) will increase due to a lack of exogenous boosting. The magnitude of any increase in zoster that might occur is dependent on rates at which adults and children mix - something that has only recently been quantified - and could be reduced by simultaneously vaccinating older individuals against shingles. This study is the first to assess the cost-effectiveness of combined varicella and zoster vaccination options and compare this to alternative programmes.
Available from: PubMed Central
- "Obviously, one solution to overcome the increase of HZ incidence among adults could be HZ vaccination (Damm et al., 2015; van Hoek et al., 2012; Bilcke et al., 2013), with highly effective vaccines being available and further developed. Van Lier et al. argue that HZ vaccination cannot be motivated from the perspective of its pushing varicella vaccination towards favourable cost-effectiveness. "
Available from: sciencedirect.com
- "• Varicella vaccination protects current children from varicella, and years later, protects them from zoster, a more severe disease caused by reactivation of varicella in people who have recovered . In current adults though, vaccination could actually result in higher zoster incidence . Hence, there are important intercohort effects, with benefits to cohorts receiving the vaccine but detriments to older cohorts. "
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ABSTRACT: Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. Published economic evaluations of vaccines mostly apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them.
Copyright © 2015. Published by Elsevier Ltd.
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ABSTRACT: The transmissible nature of communicable diseases is what sets them apart from other diseases modeled by health economists. The probability of a susceptible individual becoming infected at any one point in time (the force of infection) is related to the number of infectious individuals in the population, will change over time, and will feed back into the future force of infection. These nonlinear interactions produce transmission dynamics that require specific consideration when modeling an intervention that has an impact on the transmission of a pathogen. Best practices for designing and building these models are set out in this paper.
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