Cost-effectiveness of Varicella Vaccination Program in Iran

Varicella zoster virus is the etiologic agent of primary varicella (chickenpox) during childhood, and varicella vaccination has not been introduced in Iran. The aim of this study is to estimate cost-effectiveness of one- and two-dose Varicella Vaccination Program in Iran.

A decision-tree model was conducted to evaluate the cost-effectiveness of the Varicella Vaccination Program in a cohort of 12 months children in Iran. Epidemiologic parameters of varicella were extracted from local and international sources, and cost of disease was estimated based on societal prospective in 2015 US$. Incremental cost per disability-adjusted life years (DALY) averted calculated as final outcome. Sensitivity analysis was also performed for lower and upper estimate of incidence, DALY, and vaccine efficacy.

Considering the vaccine efficacy of 95%, for the two-dose and 85% for the one-dose vaccination, incremental cost-effectiveness ratio (ICER) per DALYs averted were US$41,531 and US$17,280, respectively. ICER has changed between (US$ 6,177-US$167,047) in lower and upper base estimate of epidemiological burden parameters in sensitivity analysis.

Varicella vaccination is not cost-effective in Iran in one-dose and two-dose scenario under the assumptions of this study in base case scenario according to the threshold of incremental cost per DALY averted less than three time of GDP per capita in Iran = US$ 14,292. One-dose vaccination program might be cost-effective in upper scenario of epidemiological burden of varicella in sensitivity analysis.