OBJECTIVES: Varicella is a highly infectious childhood disease caused by the varicella-zoster virus (VZV). Following primary infection, VZV remains latent in the body and can reactivate later in life as herpes zoster (HZ). Currently, there is no universal varicella vaccination (UVV) in the United Kingdom (UK). However, a one dose vaccination against HZ is recommended for people aged from 70 to 79 years. This study aimed to assess the public health impact and cost-effectiveness of implementing UVV on varicella and HZ in the UK.

METHODS: An age structured deterministic compartmental dynamic transmission model (DTM) was developed to assess the public health impact and cost-effectiveness of UVV with a 2-doses schedule (12 months and 18 months) in comparison to a baseline of no UVV but with an existing HZ immunization program. A 100-year time horizon with a payer and societal perspective was used and a discount rate of 3.5% was applied for both costs and outcomes. Alternative vaccination schedules and time horizons were assessed through scenario analyses.

RESULTS: Following UVV implementation, the total incidence of varicella over a 100-year time horizon was reduced by 95% with the largest reductions occurring in the first five years. Simultaneously, the total incidence of HZ reduced steadily by 98% over the same time horizon. The incremental cost-utility ratio using a 100-year time horizon and a payer’s perspective was £2,984 per QALY gained. The cost-effectiveness of UVV further increased to £7,069 per QALY gained for a 20-year time horizon. From a societal perspective, UVV was considered cost saving.

CONCLUSIONS: Introduction of UVV in the UK would result in reducing both varicella and HZ incidence. The implementation of such a vaccination program is considered cost-effective from a payer’s perspective and cost-saving from a societal one considering a willingness to pay threshold of £20,000/QALY.