Impact of universal varicella vaccination on the use and cost of antibiotics and antivirals for varicella management in the United States

PLoS One. 2022 Jun 10;17(6):e0269916. doi: 10.1371/journal.pone.0269916. eCollection 2022.

Abstract

Background: Our objective was to estimate the impact of universal varicella vaccination (UVV) on the use and costs of antibiotics and antivirals for the management of varicella among children in the United States (US).

Methods: A decision tree model of varicella vaccination, infections and treatment decisions was developed. Results were extrapolated to the 2017 population of 73.5 million US children. Model parameters were populated from published sources. Treatment decisions were derived from a survey of health care professionals' recommendations. The base case modelled current vaccination coverage rates in the US with additional scenarios analyses conducted for 0%, 20%, and 80% coverage and did not account for herd immunity benefits.

Results: Our model estimated that 551,434 varicella cases occurred annually among children ≤ 18 years in 2017. Antivirals or antibiotics were prescribed in 23.9% of cases, with unvaccinated children receiving the majority for base case. The annual cost for varicella antiviral and antibiotic treatment was approximately $14 million ($26 per case), with cases with no complications accounting for $12 million. Compared with the no vaccination scenario, the current vaccination rates resulted in savings of $181 million (94.7%) for antivirals and $78 million (95.0%) for antibiotics annually. Scenario analyses showed that higher vaccination coverage (from 0% to 80%) resulted in reduced annual expenditures for antivirals (from $191 million to $41 million), and antibiotics ($82 million to $17 million).

Conclusions: UVV was associated with significant reductions in the use of antibiotics and antivirals and their associated costs in the US. Higher vaccination coverage was associated with lower use and costs of antibiotics and antivirals for varicella management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Chickenpox Vaccine / therapeutic use
  • Chickenpox* / drug therapy
  • Chickenpox* / epidemiology
  • Chickenpox* / prevention & control
  • Child
  • Cost-Benefit Analysis
  • Herpesvirus 3, Human
  • Humans
  • United States / epidemiology
  • Vaccination

Substances

  • Anti-Bacterial Agents
  • Antiviral Agents
  • Chickenpox Vaccine

Grants and funding

This study was sponsored by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA (MSD). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. M. Pawaskar and S. Samant, are employees of MSD and own stocks in Merck & Co., Inc., Rahway, NJ, USA. P. Veeranki, and C. Harley, are employees of PRECISIONheor, which received financial support from MSD, for the execution of this research. Though they received no payment for their work on this study, J. H. Conway reports grants and personal fees from Sanofi Pasteur, Pfizer, Merck, GSK, and Centers for Disease Control outside of the submitted work while J. Fergie reports personal fees from MSD, outside the submitted work.