Pretransplant varicella vaccination is cost-effective in pediatric renal transplantation

Because of the severe complications that may result from varicella tester v irus (VZV) infection following renal transplantation (Tx), transplanted var icella-susceptible children exposed to varicella are typically given varice lla tester immunoglobulin (VZIG) as prophylaxis or are admitted and treated with parenteral acyclovir if VZIG prophylaxis fails. As both VZIG and hosp italization are costly, prevention of varicella infection by vaccination co uld potentially result in significant cost savings in addition to decreasin g 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 transplan t. Under baseline assumptions, vaccination for varicella pretransplant was a cost-effective strategy, with a cost of $211 per patient vaccinated compa red with $1,828 per patient not vaccinated. The magnitude of cost savings f rom vaccination was sensitive to variations in the cost of varicella vaccin e, the percentage of patients hospitalized for treatment with acyclovir, an d the percentage of patients exposed to varicella infection. One- and two-w ay sensitivity analyses confirmed that vaccination was the dominant cost-ef fective strategy under all conditions examined. We conclude that vaccinatio n for varicella pretransplant is cost-effective for patients with CRF, and that the magnitude of cost savings is sensitive to the cost of hospitalizat ion, the percentage of patients exposed to varicella, and the cost of varic ella vaccination. Pending results of ongoing studies of the safety and effi cacy of VZV vaccine in children with CRF, we recommend that VZV vaccine be given to all children with CRF.