The cost-effectiveness of varicella screening and vaccination in US Army recruits

Varicella outbreaks in the U.S. Army disrupt training, reduce readiness, an d represent substantial costs. Vaccination of susceptible individuals may b e cost-effective. We conducted a cost-effectiveness analysis comparing scre ening of all incoming recruits and vaccination of susceptible individuals a t either initial entry training (IET) or medical entrance processing statio n (MEPS), universal vaccination at IET, and no intervention. Primary health outcomes included the number of varicella cases prevented during the 8-wee k initial training period. The varicella hospitalization rate was 21.6 per 10,000 per year. In 100,000 recruits, 36 cases of varicella are expected at a cost of $181,000 in the absence of an intervention. Screening at IET wou ld prevent 4 cases but would cost an additional $3,255,000 more than no int ervention. Screening at MEPS would prevent 3 cases and save $521,000 per ca se prevented during the IET but would cost $2,734,000 more than no interven tion. Universal vaccination would prevent 2 cases but would cost $15,858,00 0 more than MEPS screening and $18,592,000 more than no intervention. These results are robust. Cost per case of varicella prevented ranged from $390, 000 to $7.9 million. Scarce prevention resources could be more cost-effecti vely allocated to other prevention programs.