Economic burden of varicella in children 1–12 years of age in Argentina, 2009–2014

Abstract

Background: In Argentina, varicella vaccination was included in the national schedule for mandatory immunizations in 2015. The vaccine has been shown to substantially reduce the morbidity and mortality associated with the virus. The purpose of this study was to evaluate the clinical and economic burden associated with varicella in Argentina prior to vaccine introduction.

Methods: This was a multi-center, retrospective chart review study among patients aged 1–12 years with a primary varicella diagnosis in 2009–2014 in Argentina. Healthcare resource utilization (HCRU) associated with varicella and its complications, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 United States dollars (USD).

Results: One hundred and fifty children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.8 (SD = 2.4) and 2.9 (SD = 2.2) years, respectively. One or more complications were experienced by 28.0% of outpatients and 98.7% of inpatients, the most common being skin and soft tissue infections, pneumonia, sepsis, cerebellitis, and febrile seizure. HCRU estimates included use of over-the-counter (OTC) medications (58.7% outpatients, 94.7% inpatients), prescription medications (26.7% outpatients, 77.3% inpatients), tests/procedures (13.3% outpatients, 70.7% inpatients), and consultation with allied health professionals (1.3% outpatients, 32.0% inpatients). The average duration of hospital stay was 4.9 (95% CI = 4.2–5.7) days, and the average duration of ICU stay was 4.8 (95% CI = 1.6–14.1) days. The total combined direct and indirect cost per varicella case was 2947.7 USD (inpatients) and 322.7 USD (outpatients). The overall annual cost of varicella in Argentina for children aged ≤14 years in 2015 was estimated at 40,054,378.0 USD.

Conclusion: The clinical burden of varicella in Argentina was associated with utilization of significant amounts of healthcare resources, resulting in substantial economic costs. These costs should be reduced with the recent implementation of routine vaccination of children.

Keywords:

• Vaccine-preventable disease
• varicella virus infection (chickenpox)
• pediatric
• complications
• healthcare resource utilization
• cost

Transparency

Declaration of funding

The study was funded by Merck & Co., Inc.

Declaration of financial/other relationships

Financial arrangements of the authors with companies whose products may be related to the present report are listed as follows, as declared by the authors. NG reports consultancy fees from Merck Sharp & Dohme Corp., Sanofi Pasteur, Pfizer, and Novartis. HKY, BJK, and LJW are employees of Merck & Co., Inc., Kenilworth, NJ. ER is an employee of JSS Medical Research, and a paid consultant of Merck & Co., Inc., Kenilworth, NJ. HM is an employee of Merck Sharpe & Dohme Corp. IA LLC, Carolina, Puerto Rico. Peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Previous presentations

Results from this study have been presented at the 5th ISPOR Latin America Conference in Santiago, Chile, September 6–8, 2015.

Acknowledgments

Jenaya Rickard from JSS Medical Research provided support for medical writing. Kyung Min Song, Changia Shao, and Alexandra Altland from Merck & Co., Inc., Kenilworth, NJ, provided support for study management. Viviana Romanin was involved with data collection in collaboration with Dr Giglio. Fabiana Garcia, Hector J. Abate, Macarena Uranga, and Veronica Pepino were principal investigators at individual study sites.