Cost effectiveness and budget impact of universal varicella vaccination in Russia

Figures & data

Figure 1. Cost-effectiveness model.

¹Individuals susceptible to varicella may become infected with varicella. The probability of infection is age-specific. In vaccinated individuals, it is reduced by vaccination. The effectiveness of the vaccine may decline exponentially over time.

²Following a varicella infection, the individuals become permanently immune to varicella

³Unvaccinated susceptible individuals may receive a 1st dose of varicella vaccine. Susceptible individuals who previously received the 1st dose may then receive a 2nd dose of varicella vaccine (if a 2-dose schedule is considered). All-cause death is possible from any state. Varicella-related deaths are conservatively not considered.

Table 1. Summary of base case inputs

Parameter	Value
Birth cohort size	1,481,074
% female	49%
Annual probability of varicella infection in the unvaccinated population—adjusted^Citation16	0 year: 1.66%
	1–2 years: 3.66%
	3–6 years: 8.29%
	7–14 years: 1.87%
	15–17 years: 0.68%
	18–100 years: 0.05%
Probability of being hospitalized for varicella infection^Citation17	0 year: 6.20%
	1–2 years: 2.30%
	3–6 years: 1.00%
	7–14 years: 2.00%
	15–17 years: 2.00%
	18–100 years: 5.80%
Probability of being hospitalized for breakthrough varicella infection^Citation17	0 year: 0.62%
	1–2 years: 0.23%
	3–6 years: 0.10%
	7–14 years: 0.20%
	15–17 years: 0.20%
	18–100 years: 0.58%
GP visit per natural varicella infection*^Citation18	0–100 years: 4
GP visit per breakthrough varicella infection*^Citation18	0–100 years: 5
Number of QALYs lost per one natural varicella incidence^Citation19	0–14 years: 0.004
	15–100 years: 0.005
Number of QALYs lost per one breakthrough varicella incidence^Citation19	0–14 years: 0.001
	15–100 years: 0.001
Cost per varicella hospitalization (rubles)^Citation10,Citation20	0–17 years: 39,509
	18–100 years: 32,813
GP visit cost (rubles)^Citation20	0–17 years: 484
	18–100 years: 484
Vaccine cost (rubles)^Citation21	1706.96

Note: *Expert opinion was sought.

GP: general practitioner; QALY: quality-adjusted life year.

Table 2. Cost-Effectiveness results*

	No vaccination	Vaccination – strategy I	Vaccination – strategy I vs No Vaccination	Vaccination – strategy II	Vaccination strategy II vs No Vaccination
Cases of varicella	669,847	62,165	−607,682	178,763	−491,084
Nb. of GP visits	2,679,387	290,727	−2,388,659	873,718	−1,805,668
Nb. of Hospitalizations	10,648	392	−10,256	540	−10,108
Costs of GP visits (rubles)	1,093,876,318	117,830,657	−976,045,661	378,214,804	−715,661,513
Costs of Hospitalizations (rubles)	291,887,643	10,706,768	−281,180,876	15,613,099	−276,274,544
Indirect costs (rubles)	7,924,098,160	722,254,224	−7,201,843,937	2,210,217,423	−5,713,880,738
Total vaccination costs (rubles)	-	4,896,557,207	4,896,557,207	4,498,107,249	4,498,107,249
QALYs lost	2,276	103	−2,172	211	−2,065
ICER payer perspective	-	-	1,675,338	-	1,698,151
ICER societal perspective	-	-	Dominant	-	Dominant
Costs per case averted payer perspective (rubles)	-	-	5,989	-	7,140

*Results represent total lifetime cost of varicella vaccination in the Russian Federation. Costs and outcomes were discounted to present value with a 3.5% discount rate.

GP: general practitioner; ICER: incremental cost-effectiveness ratio; Nb: number; QALYs: quality-adjusted life years.

Figure 2. Budget impact over a 10-year period (a) Strategy I – Varicella vaccine doses at 12 and 15 months (b) Strategy II – Varicella vaccine doses at 1 and 6 years compared to no vaccination.

Figure 3. Deterministic sensitivity analysis (a) Strategy I – Varicella vaccine doses at 12 and 15 months (b) Strategy II – Varicella vaccine doses at 1 and 6 years compared to no vaccination.

GP: general practitioner; ICER: incremental cost-effectiveness ratio; Nb: number; QALY: quality-adjusted life year; TPP: third-party payer.

Figure 4. Probabilistic sensitivity analysis (a) Strategy I – Varicella vaccine doses at 12 and 15 months (b) Strategy II – Varicella vaccine doses at 1 and 6 years compared to no vaccination.

The red dot in the middle represents the base case among other 1000 other simulations in blue around that.

Vankova O, Ulanova T, Loparev V. P1438 seroprevalence and genotyping of varicella zoster virus strains in the Russian Federation. Int J Antimicrob Agents. 2007;29. doi:10.1016/S0924-8579(07)71277-3 .

 Web of Science ®Google Scholar

Peredelskaya EA, Safyanova TV, Druchanov MM. Clinical and epidemiological characteristics of chickenpox in children aged 0–17 in Barnaul. J Infectol. 2021;13:66–70. doi:10.22625/2072-6732-2021-13-1-66-70.

 Google Scholar

Druzhinina T. Chickenpox in the Yaroslavl region. Economic efficiency of varicellation of one age-group of children. Pediatr Pharmacol (New York). 2012;9:14–21. doi:10.15690/pf.v9i5.450 .

 Google Scholar

Brisson M, Edmunds WJ. Varicella vaccination in England and Wales: cost-utility analysis. Arch Dis Child. 2003;88:862–69. doi:10.1136/adc.88.10.862 .

 PubMed Web of Science ®Google Scholar

Quian J, Rüttimann R, Romero C, Dall’-Orso P, Cerisola A, Breuer T, Greenberg M, Verstraeten T. Impact of universal varicella vaccination on 1-year-olds in Uruguay: 1997-2005. Arch Dis Child. 2008;93:845–50. doi:10.1136/adc.2007.126243 .

 PubMed Web of Science ®Google Scholar

Government of the Russian Federation. Decree of the Government of the Russian Federation of December 8, 2017 No. 1492 “on the program of state guarantees of free provision of medical care to citizens for 2018 and for the planning period of 2019 and 2020”. Moscow: Ministry of Health of the Russian Federation; 2017 [accessed 2021 May 9]. http://www.garant.ru/products/ipo/prime/doc/71729300/ .

 Google Scholar

State Register of Medicine. State register of maximum selling prices. Russian Federation; 2009 [accessed 2021 Apr 13]. http://grls.rosminzdrav.ru/PriceLims.aspx?Torg=%d0%92%d0%b0%d1%80%d0%b8%d0%bb%d1%80%d0%b8%d0%ba%d1%81&Mnn=&RegNum=&Mnf=&Barcode=&Order=&PageSize=8&orderby=pklimprice&orderType=desc&pagenum=1 .

 Google Scholar