G J Baracco1, S Eisert2, S Saavedra3, P Hirsch4, M Marin5, I R Ortega-Sanchez5. 1. National Center for Occupational Health and Infection Control, Veterans Health Administration Office of Public Health, Gainesville, FL; Miami Veterans Affairs Healthcare System, Miami, FL; University of Miami Miller School of Medicine, Miami, FL. Electronic address: gio.baracco@va.gov. 2. National Center for Occupational Health and Infection Control, Veterans Health Administration Office of Public Health, Gainesville, FL; University of South Florida, College of Public Health, Tampa, FL. 3. Veterans Affairs Caribbean Healthcare System, San Juan, Puerto Rico. 4. Occupational Health, Veterans Health Administration Office of Public Health, Washington, DC. 5. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
BACKGROUND: Exposure to patients with varicella or herpes zoster causes considerable disruption to a health care facility's operations and has a significant health and economic impact. However, practices related to screening for immunity and immunization of health care personnel (HCP) for varicella vary widely. METHODS: A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of screening and vaccinating HCP for varicella. The outcomes are presented as probability of acquiring varicella, economic impact of varicella per employee per year, and cost to prevent additional cases of varicella. Monte Carlo simulations and 1-way sensitivity analyses were performed to address the uncertainties inherent to the model. Alternative epidemiologic and technologic scenarios were also analyzed. RESULTS: Performing a clinical screening followed by serologic testing of HCP with negative history diminished the cost impact of varicella by >99% compared with not having a program. Vaccinating HCP with negative screen cost approximately $50,000 per case of varicella prevented at the current level of U.S. population immunity, but was projected to be cost-saving at 92% or lower immunity prevalence. Improving vaccine acceptance rates and using highly sensitive assays also optimize cost-effectiveness. CONCLUSION: Strategies relying on screening and vaccinating HCP for varicella on employment were shown to be cost-effective for health care facilities and are consistent with current national guidelines for varicella prevention. Published by Elsevier Inc.
BACKGROUND: Exposure to patients with varicella or herpes zoster causes considerable disruption to a health care facility's operations and has a significant health and economic impact. However, practices related to screening for immunity and immunization of health care personnel (HCP) for varicella vary widely. METHODS: A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of screening and vaccinating HCP for varicella. The outcomes are presented as probability of acquiring varicella, economic impact of varicella per employee per year, and cost to prevent additional cases of varicella. Monte Carlo simulations and 1-way sensitivity analyses were performed to address the uncertainties inherent to the model. Alternative epidemiologic and technologic scenarios were also analyzed. RESULTS: Performing a clinical screening followed by serologic testing of HCP with negative history diminished the cost impact of varicella by >99% compared with not having a program. Vaccinating HCP with negative screen cost approximately $50,000 per case of varicella prevented at the current level of U.S. population immunity, but was projected to be cost-saving at 92% or lower immunity prevalence. Improving vaccine acceptance rates and using highly sensitive assays also optimize cost-effectiveness. CONCLUSION: Strategies relying on screening and vaccinating HCP for varicella on employment were shown to be cost-effective for health care facilities and are consistent with current national guidelines for varicella prevention. Published by Elsevier Inc.
Authors: Corrado Lanera; Ileana Baldi; Andrea Francavilla; Elisa Barbieri; Lara Tramontan; Antonio Scamarcia; Luigi Cantarutti; Carlo Giaquinto; Dario Gregori Journal: Int J Environ Res Public Health Date: 2022-05-13 Impact factor: 4.614
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