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  • Varicella Vaccine Assessment Report 2012

    National Health Committee Page 1 of 61

    Varicella Vaccination in New Zealand:

    NHC Assessment 2012

    In 2014 the National Health Committee (NHC) received a request for a copy of the NHC’s assessment report on varicella (chicken pox) vaccination. This report was part of early assessment work the NHC undertook in both varicella and rotavirus vaccination in 2011/12, before responsibility for the management and purchasing of vaccines (including considering any changes to the National Immunisation Schedule) transferred from the Ministry of Health to New Zealand’s Pharmaceutical management Agency (PHARMAC). The NHC provided PHARMAC copies of the vaccine assessment reports and recommendations papers in 2013 and formal NHC recommendations on this work were never provided to the Minister of Health. Following the principal of open disclosure the Committee has decided to release the package of NHC vaccination assessments and recommendations on their website (www.nhc.health.govt.nz).

  • Varicella Vaccine Assessment Report 2012

    National Health Committee Page 2 of 61

    Table of Contents

    List of Tables ................................................................................................................. 4

    Executive Summary ...................................................................................................... 5

    Policy Question ............................................................................................................. 6

    Who initiated or commissioned the report? ............................................................... 6

    Why is an assessment needed right now? ................................................................ 6

    Which decision is it going to support? ....................................................................... 6

    Who represents the primary target audience for the report? ..................................... 7

    Background ................................................................................................................... 7

    Condition & target group ........................................................................................... 7

    Nature of the health problem or disease ............................................................... 7

    Epidemiology and burden of the disease .............................................................. 9

    Treatments for the disease & current practice .................................................... 10

    Technology status ................................................................................................... 11

    Intervention type ................................................................................................. 11

    Requirements for its use .................................................................................... 11

    Current technology status................................................................................... 12

    Research Questions .................................................................................................... 13

    Clinical safety & effectiveness ................................................................................. 13

    Value for money ...................................................................................................... 13

    Societal & ethical considerations ............................................................................ 14

    Feasibility of adoption in the health system ............................................................. 14

    Policy congruence .............................................................................................. 14

    Organisational issues ......................................................................................... 14

    Legal considerations .......................................................................................... 14

    Budget impact .................................................................................................... 14

    Methodology ................................................................................................................ 15

    Narrative literature review ....................................................................................... 15

    Internet ................................................................................................................... 16

    Ministry of Health knowledge systems .................................................................... 16

    Summary of latest New Zealand evaluation report .................................................. 16

    Results & Discussion ................................................................................................... 17

    Clinical safety & effectiveness ................................................................................. 17

    What is the clinical safety and efficacy of vaccines for varicella in children aged 0-5 years? .......................................................................................................... 17

    Safety ................................................................................................................. 17

  • Varicella Vaccine Assessment Report 2012

    National Health Committee Page 3 of 61

    Effectiveness ...................................................................................................... 18

    Outstanding uncertainty ..................................................................................... 20

    Value for money ...................................................................................................... 21

    What costs were included? ................................................................................. 22

    What non-financial benefits are expected? ......................................................... 23

    What is the cost-effectiveness of adding the varicella vaccine to the existing childhood immunisation schedule in New Zealand as a separate shot at 15 months and 4 years (Option 1), relative to a counterfactual scenario where the varicella vaccine is not available at all (Option 2)? ............................................. 24

    Would the vaccine be more cost-effective if it were targeted to different population groups? If so, which groups? ........................................................... 27

    Does reducing the number of doses affect the cost-effectiveness of the vaccine?28

    Societal & ethical considerations ............................................................................ 28

    Acceptability ....................................................................................................... 29

    Equity & Ethics ................................................................................................... 31

    Psychological considerations ............................................................................. 33

    Feasibility of adoption in the health system ............................................................. 33

    Policy congruence .............................................................................................. 34

    Organisational issues ......................................................................................... 34

    Legal issues ....................................................................................................... 37

    Budget impact .................................................................................................... 37

    Funding .............................................................................................................. 41

    Conclusion .................................................................................................................. 42

    Options ........................................................................................................................ 42

    Glossary of Terms ....................................................................................................... 45

    References .................................................................................................................. 48

    Appendix 1: Immunisation Programme ....................................................................... 54

    Appendix 2: HTA repositories searched ..................................................................... 55

    Appendix 3: Search strategies .................................................................................... 58

  • Varicella Vaccine Assessment Report 2012

    National Health Committee Page 4 of 61

    List of Tables Table 1: Summary of the different quality of life weights for varicella in the literature ... 8

    Table 2: Registration status of NZ Varicella Vaccines ................................................ 17

    Table 3: Costs included in the economic evaluation of universal varicella vaccination ................................................................................................................................... 22

    Table 4: Estimated annual costs of delivering a universal varicella vaccination programme with 100% uptake. ................................................................................... 38

    Table 5: Strengths and weakness of different op