Análisis de costo-efectividad de la vacuna contra varicela en niños de 15 meses para Colombia, usando un modelo de simulación dinámica
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Rivera Triana, Diana Patricia
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Abstract
Introduction Chickenpox is a highly contagious infectious disease that has a wide
spectrum of complications, even death. Since 1998, the WHO recommends varicella
vaccination as a public health strategy aimed at reducing mortality and reduce the
burden of disease.
Objective To assess the cost-effectiveness of varicella vaccine, incorporating the effect
herd in a dynamic model, in children under 15 months in Colombia.
Methods A cost-effectiveness analysis of a program of routine varicella vaccination in
Colombian children less than 15 months was performed. From a systematic review of
the literature data vaccine effectiveness including estimation of the effect of herd
immunity were obtained.
A critical analysis of the available studies and sources of information on the state of
chickenpox in our context was conducted.
A model of the transmission dynamics of varicella dependent on age and time to
estimate the incidence of varicella for a 30-year simulation period was used, and the
varying force of infection is incorporated to include the effect of herd. The perspective
was referred to the third party payer. The measure of effect considered were years of
disability-adjusted life prevented by vaccination. EL time horizon was lifetime 75 years
The analysis includes medical costs updated to 2013, and reasons incremental cost
effectiveness of vaccination against varicella was calculated by comparison not to
vaccinate people. DALY’s difference was calculated to obtain the cost per additional
DALY averted.
Analysis of deterministic sensitivity was performed in one way on the costs (vaccination
costs, costs of adverse events, hospitalization costs), the effectiveness of the vaccine,
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vaccination coverage, discount rates and model assumptions. Probabilistic sensitivity
analyzes were performed by building curves. Discount rate was 3%.
Results Under the assumptions of the effectiveness of a single dose of 95% and 80%
coverage, it was concluded that the program could prevent 21,559,021 cases and 1,833
deaths. With regard to the economic analysis, it introduced universal vaccination without
a discount of 26,84 cost effectiveness and incremental cost effectiveness ratio
6.031.690. The sensitivity analysis showed a cost effectiveness vaccination strategy
longer if the cost per dose is greater than $ 20,000 and if they require strengthening
after 10 years this strategy is cost effective if price per dose is less than $ 22.000
Conclusions The implementation of the varicella vaccine and the effect of herd
immunity conferring it a very cost-effectiveness alternative for Colombia.
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