Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 786-792 (doi:10.1542/peds.2004-0012)
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Decline in Varicella-Related Hospitalizations and Expenditures for Children and Adults After Introduction of Varicella Vaccine in the United States

Matthew M. Davis, MD, MAPP*,{ddagger}, Mitesh S. Patel, BS Chem* and Achamyeleh Gebremariam, MS*

* Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
{ddagger} Division of General Internal Medicine and the Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan

Objective. Universal childhood immunization against varicella in the United States, first recommended in 1995, was predicted to lead to significant decreases in varicella-related hospitalization rates and corresponding charges. Previous studies have not found such effects. We studied trends in varicella-related hospitalization rates and associated charges before and after introduction of varicella vaccine.

Methods. We examined hospitalization and charge data from the Nationwide Inpatient Sample for the years 1993–2001, representative of national hospitalization patterns for children and adults. We derived weighted estimates of population-adjusted, varicella-related hospitalization rates and inflation-adjusted, varicella-related hospital charges.

Results. The annual varicella-related hospitalization rate exceeded 0.5 hospitalizations per 10 000 US population from 1993 to 1995, declined to 0.26 per 10 000 by 1999, and again halved to 0.13 per 10 000 by 2001. Hospitalization rates declined most substantially among individuals primarily targeted for vaccination (0- to 4-year-old children) but decreased among youths aged 5 to 19 years and among adults as well. Concomitantly, varicella-related hospital charges declined from $161.1 million (95% confidence interval: $130.5 million–$191.8 million) in 1993 to $66.3 million (95% confidence interval: $50.9 million–$81.7 million) in 2001 (all 2001 $US). Among expected primary payers, inflation-adjusted declines in varicella-related hospital discharges–related charges accrued to Medicaid, private insurance, and "other" payers (including uninsured and self-pay) but not to Medicare.

Conclusions. This national analysis indicates a clinically and statistically significant reduction in varicella-related hospitalizations for children and adults associated with childhood varicella immunization in the United States and a corresponding significant decrease in hospital charges.

Key Words: varicella vaccine • hospitalization • health economics

Abbreviations: NIS, Nationwide Inpatient Sample • ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification • HCUP, Healthcare Cost and Utilization Project • VRHD, varicella-related hospital discharge • CI, confidence interval • VFC, Vaccines for Children

Accepted Apr 8, 2004.




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