OBJECTIVES :

To assess the clinical and economic burden of varicella in Mexico, where the varicella vaccine is not publicly available, except in children undergoing bone marrow transplantation.

METHODS

Annual societal costs were estimated for a base scenario by multiplying per-patient costs with varicella incidence from the Mexican epidemiological surveillance system (SUIVE), adjusted for the estimated proportion of public healthcare centers who do not regularly report. In a sensitivity analysis where cost calculations remained stable, epidemiological estimates ranged between raw SUIVE varicella rates (lower bound), and a 25% additive increment to reflect the estimated proportion of public sector patients who utilize private services (upper bound).

Outcome Measures

Clinical complications; health care resource utilization (HCRU)(frequency and type) including outpatient visits, allied healthcare contacts, doctor’s visits, tests/procedures performed, prescription and over-the-counter (OTC) medications, hospitalizations, and Emergency Room (ER) and Intensive Care Unit(ICU) visits/stays.

RESULTS :

Charts of 152 varicella patients were included, of which 75 and 77 were outpatients and inpatients [mean (SD) age=3.0 (3.2) and 2.6 (3.5) years, respectively]. Inpatients reported higher complication rates (inpatients vs. outpatients: 84.4% vs. 6.7%), prescription medication use (94.8% vs. 80.0%), over-the-counter medications use (71.4% vs. 80.0%), tests/procedures (87.0% vs. 5.3%), and allied health professional consultations (61.0% vs. 12.0%). Direct/indirect costs per case were $198/$42 (outpatients), and $5,633/$175 (inpatients). Estimated societal costs related to varicella ranged from $77-$218 million.

CONCLUSIONS :

Substantial clinical and associated public health and economic burden were observed among children with primary varicella infection in Mexico. These results highlight the need for implementation of a childhood varicella vaccination program.