Manjiri Pawaskar (United States of America)
Merck & Co., Inc., Center for Observational and Real-world Evidence (CORE)Presenter of 2 Presentations
IMPACT OF UNIVERSAL VARICELLA VACCINATION ON THE USE OF ANTIBIOTIC AND ANTIVIRAL FOR VARICELLA MANAGEMENT IN THE UNITED STATES (ID 542)
Abstract
Background
To investigate the impact of universal varicella vaccination (UVV) on potential exposure to antibiotics and antivirals and associated costs for the treatment of varicella among US children.
Methods
A decision tree model of vaccination, varicella infections and treatment decisions was developed. 10 million replications were run using probabilistic sampling. Results were extrapolated to the 2017 population of 73.5 million US children ≤18 years in cross-section of one year. Parameters (vaccination and complications rates, treatment costs) were populated from literature. Expert opinion helped determine correct treatment for each vignette. Treatment decision likelihood were estimated using online survey results where 153 Health care professionals made treatment recommendations for 8 patient varicella vignettes.
Results
In a scenario with no UVV, our model estimated 1,053,087 antibiotic and 1,705,841 antiviral prescriptions would be dispensed annually to treat varicella. Under existing UVV in US, antibiotic and antiviral prescriptions were reduced by 95% and 93% respectively leading to $87 million annual cost-savings. Treatment in unvaccinated children (4%) under UVV accounted for 61% of antibiotic and antiviral prescriptions costing $18 million annually. While vaccination offers significant protection, breakthrough cases of varicella result in 16,961 antibiotic and 50,824 antiviral prescriptions annually.
Conclusions
Our model estimated substantial reduction in antibiotic and antiviral use among US children for treatment of varicella due to UVV. Antibiotics and antivirals are frequently used for managing varicella infection among unvaccinated children, sometimes inappropriately. Strategies to improve vaccination coverage and education to improve management of cases may further reduce clinical and economic burden of varicella in U.S.