This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Tracy A. Lieu, MD, MPH; Stephen L. Cochi, MD; Steven B. Black, MD; M. Elizabeth Halloran, MD, DSc; Henry R. Shinefield, MD; Sandra J. Holmes, PhD; Melinda Wharton, MD; A. Eugene Washington, MD, MSc

JAMA. 1994;271(5):375-381.

Abstract
Objective.
—To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children.

Methods.
—Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database.

Results.
—A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%.

Conclusions.
—A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

(JAMA. 1994;271:375-381)

Author Affiliations
From the Robert Wood Johnson Clinical Scholars Program and Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco (Dr Lieu); Division of Research, The Permanente Medical Group, Oakland, Calif (Dr Lieu); Surveillance, Investigations, and Research Branch, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Cochi, Holmes, and Wharton); Kaiser Permanente Pediatric Vaccine Study Center, Oakland, Calif (Drs Black and Shinefield); Division of Biostatistics, Emory University School of Public Health, Atlanta, Ga (Dr Halloran); and MEDTEP Research Center on Minority Populations, Institute for Health Policy Studies, and Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco (Dr Washington).

Footnotes
Reprint requests to Division of Research, The Permanente Medical Group, 3451 Piedmont Ave, Oakland, CA 94611 (Dr Lieu).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Burden and Economic Cost of Group A Streptococcal Pharyngitis
Pfoh et al.
Pediatrics 2008;121:229-234.
ABSTRACT | FULL TEXT  

Cost-effectiveness and Potential Impact of Rotavirus Vaccination in the United States
Widdowson et al.
Pediatrics 2007;119:684-697.
ABSTRACT | FULL TEXT  

Physician Attitudes Regarding Breakthrough Varicella Disease and a Potential Second Dose of Varicella Vaccine
Davis et al.
Pediatrics 2007;119:258-264.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Routine Childhood Vaccination for Hepatitis A in the United States
Rein et al.
Pediatrics 2007;119:e12-e21.
ABSTRACT | FULL TEXT  

Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
Hornberger and Robertus
ANN INTERN MED 2006;145:317-325.
ABSTRACT | FULL TEXT  

The Case against Universal Varicella Vaccination
Goldman
International Journal of Toxicology 2006;25:313-317.
ABSTRACT | FULL TEXT  

Impact of Model, Methodological, and Parameter Uncertainty in the Economic Analysis of Vaccination Programs
Brisson and Edmunds
Med Decis Making 2006;26:434-446.
ABSTRACT  

Economic Analysis of Prevaccination Serotesting Compared With Presumptive Immunization for Polio, Diphtheria, and Tetanus in Internationally Adopted and Immigrant Infants
Cohen and Veenstra
Pediatrics 2006;117:1650-1655.
ABSTRACT | FULL TEXT  

Diagnosis and Management of Pharyngitis in a Pediatric Population Based on Cost-Effectiveness and Projected Health Outcomes
Van Howe and Kusnier
Pediatrics 2006;117:609-619.
ABSTRACT | FULL TEXT  

Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001
Zhou et al.
Arch Pediatr Adolesc Med 2005;159:1136-1144.
ABSTRACT | FULL TEXT  

Management of Influenza Symptoms in Healthy Children: Cost-effectiveness of Rapid Testing and Antiviral Therapy
Rothberg et al.
Arch Pediatr Adolesc Med 2005;159:1055-1062.
ABSTRACT | FULL TEXT  

Varicella Vaccine, Cost-effectiveness Analyses, and Vaccination Policy
Davis
JAMA 2005;294:845-846.
FULL TEXT  

Overcoming Economic Barriers To The Optimal Use Of Vaccines
Lieu et al.
Health Aff (Millwood) 2005;24:666-679.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Conjugate Meningococcal Vaccination Strategies in the United States
Shepard et al.
Pediatrics 2005;115:1220-1232.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Defending against Bioterrorism: A Comparison of Vaccination and Antibiotic Prophylaxis against Anthrax
Fowler et al.
ANN INTERN MED 2005;142:601-610.
ABSTRACT | FULL TEXT  

Preventing Varicella-Zoster Disease
Hambleton and Gershon
Clin. Microbiol. Rev. 2005;18:70-80.
ABSTRACT | FULL TEXT  

Decline in Varicella-Related Hospitalizations and Expenditures for Children and Adults After Introduction of Varicella Vaccine in the United States
Davis et al.
Pediatrics 2004;114:786-792.
ABSTRACT | FULL TEXT  

The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers
Fetterolf and West
American Journal of Medical Quality 2004;19:48-55.
ABSTRACT  

Varicella vaccination in England and Wales: cost-utility analysis
Brisson and Edmunds
Arch. Dis. Child. 2003;88:862-869.
ABSTRACT | FULL TEXT  

An Outbreak of Varicella despite Vaccination
Giusti et al.
NEJM 2003;348:1405-1407.
FULL TEXT  

Childhood Vaccine Purchase Costs in the Public Sector: Past Trends, Future Expectations
Davis et al.
AJPH 2002;92:1982-1987.
ABSTRACT | FULL TEXT  

Review: varicella vaccination is effective in children
Uhari
Evid. Based Med. 2002;7:9-9.
FULL TEXT  

Vaccination to prevent varicella and shingles
Breuer
J. Clin. Pathol. 2001;54:743-747.
ABSTRACT | FULL TEXT  

Current topic: Varicella vaccination{---}a critical review of the evidence
Skull and Wang
Arch. Dis. Child. 2001;85:83-90.
FULL TEXT  

Ethics and Immunization Policy: Promoting Dialogue to Sustain Consensus
Feudtner and Marcuse
Pediatrics 2001;107:1158-1164.
ABSTRACT | FULL TEXT  

Cost-Benefit Analysis of a Strategy to Vaccinate Healthy Working Adults Against Influenza
Nichol
Arch Intern Med 2001;161:749-759.
ABSTRACT | FULL TEXT  

Economic Impact of Influenza Vaccination in Preschool Children
Cohen and Nettleman
Pediatrics 2000;106:973-976.
ABSTRACT | FULL TEXT  

The Cost-effectiveness of Adolescent Hepatitis A Vaccination in States With the Highest Disease Rates
Jacobs et al.
Arch Pediatr Adolesc Med 2000;154:763-770.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Childhood Immunization Reminder/Recall Systems in Urban Private Practices
Franzini et al.
Pediatrics 2000;106:177-183.
ABSTRACT | FULL TEXT  

Projected Cost-effectiveness of Pneumococcal Conjugate Vaccination of Healthy Infants and Young Children
Lieu et al.
JAMA 2000;283:1460-1468.
ABSTRACT | FULL TEXT  

Varicella Vaccine Update
Committee on Infectious Diseases
Pediatrics 2000;105:136-141.
ABSTRACT | FULL TEXT  

Cost of Chickenpox in Canada: Part I. Cost of Uncomplicated Cases
Law et al.
Pediatrics 1999;104:1-6.
ABSTRACT | FULL TEXT  

Cost of Chickenpox in Canada: Part II. Cost of Complicated Cases and Total Economic Impact
Law et al.
Pediatrics 1999;104:7-14.
ABSTRACT | FULL TEXT  

Cost Effectiveness Ratio: An Often Misunderstood Term • Response
Gan et al.
Anesth. Analg. 1999;88:1191-1192.
FULL TEXT  

Varicella Immunization Practices and the Factors That Influence Them
Schaffer and Bruno
Arch Pediatr Adolesc Med 1999;153:357-362.
ABSTRACT | FULL TEXT  

Complications of varicella in a defined central European population
Jaeggi et al.
Arch. Dis. Child. 1998;79:472-477.
ABSTRACT | FULL TEXT  

Reactions of Pediatricians to the Recommendation for Universal Varicella Vaccination
Newman and Taylor
Arch Pediatr Adolesc Med 1998;152:792-796.
ABSTRACT | FULL TEXT  

More on Varicella Immunization
Wack
NEJM 1998;338:1927-1927.
FULL TEXT  

Cost-effectiveness Analysis of a Rotavirus Immunization Program for the United States
Tucker et al.
JAMA 1998;279:1371-1376.
ABSTRACT | FULL TEXT  

Vaccination for Varicella--Just Do It!
Shapiro and LaRussa
JAMA 1997;278:1529-1530.
ABSTRACT  

Concerns Regarding Universal Varicella Immunization: Time Will Tell
MacFarlane et al.
Arch Fam Med 1997;6:537-541.
ABSTRACT  

A Long-term Prospective Study of Varicella Vaccine in Healthy Children
Johnson et al.
Pediatrics 1997;100:761-766.
ABSTRACT | FULL TEXT  

Pediatrics and Adolescent Medicine
Santoli and DeAngelis
JAMA 1997;277:1889-1890.
 

Therapy for Acute Otitis Media: Preference of Parents for Oral or Parenteral Antibiotic
Bauchner et al.
Arch Pediatr Adolesc Med 1996;150:396-399.
ABSTRACT  

Physician and Parent Opinions: Are Children Becoming Pincushions From Immunizations?
Woodin et al.
Arch Pediatr Adolesc Med 1995;149:845-849.
ABSTRACT  

Immunisation against chickenpox
Ross and Lantos
BMJ 1995;310:2-3.
FULL TEXT  

The Productivity Costs of Providing or Withholding Treatment
Anstadt
JAMA 1994;272:1578-1578.
ABSTRACT  

Where Is the Health in Health System Reform?
Fielding and Halfon
JAMA 1994;272:1292-1296.
ABSTRACT  

Routine Childhood Varicella Vaccination
Lebel
JAMA 1994;271:1906-1906.
ABSTRACT  

Routine Childhood Varicella Vaccination
Smukler
JAMA 1994;271:1906-1906.
ABSTRACT