{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:15:00Z","timestamp":1782947700620,"version":"3.54.5"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Comprehensive cost-effectiveness analyses of introducing varicella and\/or herpes zoster vaccination in the Swedish national vaccination programme.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design<\/jats:title>\n<jats:p>Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Setting<\/jats:title>\n<jats:p>National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Participants<\/jats:title>\n<jats:p>Hypothetical cohorts of people aged 12 months and 65-years at baseline.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Interventions<\/jats:title>\n<jats:p>Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Main outcome measures<\/jats:title>\n<jats:p>Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Results<\/jats:title>\n<jats:p>It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec008\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective\u2013the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0251644","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T18:00:39Z","timestamp":1620928839000},"page":"e0251644","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2339-0529","authenticated-orcid":true,"given":"Ellen","family":"Wolff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Widgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Scalia Tomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Roth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiia","family":"Lep","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f6ren","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"issue":"2","key":"pone.0251644.ref001","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jcv.2006.07.012","article-title":"Changes in seroprevalence to four herpesviruses over 30 years in Swedish children aged 9\u201312 years","volume":"37","author":"A Svahn","year":"2006","journal-title":"J Clin Virol"},{"key":"pone.0251644.ref002","first-page":"1145","volume-title":"Vaccines.","author":"A Gershon","year":"2018","edition":"7"},{"issue":"25","key":"pone.0251644.ref003","first-page":"265","article-title":"Varicella and herpes zoster vaccines: WHO position paper, June 2014","volume":"89","year":"2014","journal-title":"Wkly Epidemiol Rec"},{"key":"pone.0251644.ref004","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/1741-7015-7-26","article-title":"Varicella vaccination in Europe\u2014taking the practical approach","volume":"7","author":"P Bonanni","year":"2009","journal-title":"BMC Med"},{"issue":"5","key":"pone.0251644.ref005","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/01.inf.0000122606.88429.8f","article-title":"Consensus: varicella vaccination of healthy children\u2014a challenge for Europe","volume":"23","author":"European Working Group on V","year":"2004","journal-title":"Pediatr Infect Dis J"},{"issue":"11","key":"pone.0251644.ref006","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1111\/j.1742-1241.2005.00647.x","article-title":"Confederation of the European Specialists of Paediatrics \/European Academy of Paediatrics CE. 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