Because of the severe complications that may result from varicella zoster virus (VZV)
infection following
renal transplantation (Tx), transplanted
varicella-susceptible children exposed to
varicella are typically given
varicella zoster immunoglobulin (
VZIG) as prophylaxis or are admitted and treated with parenteral
acyclovir if
VZIG prophylaxis fails. As both
VZIG and hospitalization are costly, prevention of
varicella infection by vaccination could potentially result in significant cost savings in addition to decreasing morbidity and mortality. To test this hypothesis, we developed a decision-analysis model to evaluate the cost-effectiveness of vaccinating patients with
chronic renal failure (CRF) against
varicella prior to renal transplant. Under baseline assumptions, vaccination for
varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compared with $1,828 per patient not vaccinated. The magnitude of cost savings from vaccination was sensitive to variations in the cost of
varicella vaccine, the percentage of patients hospitalized for treatment with
acyclovir, and the percentage of patients exposed to
varicella infection. One- and two-way sensitivity analyses confirmed that vaccination was the dominant cost-effective strategy under all conditions examined. We conclude that vaccination for
varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalization, the percentage of patients exposed to
varicella, and the cost of
varicella vaccination. Pending results of ongoing studies of the safety and efficacy of VZV
vaccine in children with CRF, we recommend that VZV
vaccine be given to all children with CRF.