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Varicella vaccination still cost-effective despite hypothesized shortened asthma onset
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Recent findings published in The Pediatric Infectious Disease Journal showed that chickenpox vaccination in the United States remained cost-effective even when considering a hypothesized shortened onset of asthma.
“A relationship between asthma and varicella may be based on several proposed mechanisms including the ‘hygiene hypothesis’ theory, which states that Th1 responses induced by microbial stimulation can counterbalance allergen-induced Th2 responses, leading to observation that improved hygiene is associated with increased hay fever, allergic rhinitis and eczema.” Tamar A. Smith-Norowitz, PhD, associate professor in the division of infectious diseases at the State University of New York, Brooklyn, and colleagues wrote. “Thus, it has been speculated that varicella infection offers protection against the onset of asthma in childhood and adolescence.”
Working in the same laboratory as Smith-Norowitz and colleagues, Silverberg and colleagues previously reported that the average onset of asthma occurred 9.4 years after varicella infection and approximately 3 years after vaccination. To determine if this finding would impact the cost-effectiveness of universal varicella vaccine coverage, Smith-Norowitz and colleagues created a decision analysis model to estimate the costs and health effects of the 2-dose vaccine, while assuming Silverberg’s finding to be true. In the model, they considered almost 4 million individuals entering the population and predicted the number of asthma and varicella cases, deaths, and costs associated with them. Three scenarios were compared: A varicella vaccination program without delayed asthma onset, a program with delayed onset, and delayed onset with no program.
When asthma onset was delayed, the researchers determined that the vaccine program still proved more cost-effective than no program. Even with asthma onset delayed 9 years after infection, universal vaccination saved $914 million. The researchers pointed out, however, that vaccination may lead to increased asthma morbidity and mortality in cases of delayed asthma onset.
This study confirmed previous findings that universal varicella vaccination is a cost-effective program, the researchers wrote.
“Furthermore, children with asthma on steroid therapy are at increased risk of severe varicella disease, as well as mortality,” the researchers wrote. “As such, children with asthma have many reason to benefit from vaccination.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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