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Pretransplant varicella vaccination is cost-effective in pediatric renal transplantation
A D Olson1, T C Shope, J T Flynn
1Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA. olsona@centocor.com
Insights
Vaccinating children with chronic renal failure against varicella before a kidney transplant is cost-effective. This strategy prevents severe complications and saves costs associated with immunoglobulin prophylaxis and hospitalization.
Area of Science:
- Immunology
- Nephrology
- Health Economics
Background:
- Varicella zoster virus (VZV) infection poses severe risks for children undergoing renal transplantation (Tx).
- Current prophylaxis involves varicella zoster immunoglobulin (VZIG) or parenteral acyclovir, both incurring significant costs and potential hospitalization.
Purpose of the Study:
- To evaluate the cost-effectiveness of pre-transplant varicella vaccination in children with chronic renal failure (CRF).
- To determine if vaccination offers a more economical approach to preventing VZV complications in this vulnerable population.
Main Methods:
- A decision-analysis model was developed to compare costs of vaccination versus standard prophylaxis/treatment.
- Sensitivity analyses were performed to assess the impact of variable costs and exposure rates.
Main Results:
- Pre-transplant varicella vaccination was found to be a dominant cost-effective strategy.
- Vaccination cost was $211 per patient, compared to $1,828 per unvaccinated patient under baseline assumptions.
- Cost savings were sensitive to vaccine cost, hospitalization rates, and varicella exposure percentages.
Conclusions:
- Pre-transplant varicella vaccination is a cost-effective measure for children with CRF awaiting renal transplantation.
- The study recommends VZV vaccination for all children with CRF, pending further safety and efficacy data in this population.
Abstract:
Because of the severe complications that may result from varicella zoster virus (VZV) infection following renal transplantation (Tx), transplanted varicella-susceptible children exposed to varicella are typically given varicella zoster immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hospitalization are costly, prevention of varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision-analysis model to evaluate the cost-effectiveness of vaccinating patients with chronic renal failure (CRF) against varicella prior to renal transplant. Under baseline assumptions, vaccination for varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compared with $1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of varicella vaccine, the percentage of patients hospitalized for treatment with acyclovir, and the percentage of patients exposed to varicella infection. One- and two-way sensitivity analyses confirmed that vaccination was the dominant cost-effective strategy under all conditions examined. We conclude that vaccination for varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to varicella, and the cost of varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF.