Varicella vaccination in Hungary and Poland: optimization of public benefits from prophylaxis technologies in the time of austerity^**

*László Szabó^{1, 2}, Teresa Jackowska^{3, 4}, Zoltán Kaló^{5, 6} , Andrea Kulcsár⁷, Zsófia Mészner⁸, Zsuzsanna Molnár⁹, Jacek Wysocki¹⁰, Peter Wutzler¹¹, Judit Kormos-Tasi², Christophe Sauboin¹²

Summary
As an international collaboration between the Hungarian Pediatric Society and the Polish Foundation for the Development of Paediatrics, multidisciplinary expert group meeting was organized to analyze the current situation and the results of the work performed on varicella prevention in Poland and in Hungary (ie. burden of disease, public health considerations of primary preventive technologies), and to discuss the possible modification in vaccination practice based on the US and German experience and health economic considerations.
Varicella (chickenpox) is a highly contagious disease predominantly affecting children aged 1-9 years, and approximately
80-90% of children are seropositive for VZV by the age of 15 years. In 2-6% of all cases potentially serious complications can occur in previously healthy children and adults. According to the European surveillance network, European population is highly infected by VZV, and vaccine uptake is extremely poor. Routine childhood immunization against varicella may be considered in countries where (1) varicella is relatively important public health and socioeconomic problem; (2) vaccine is affordable; and (3) high and sustained vaccine coverage can be achieved. Even in difficult economic periods, when health care budgets are seriously limited, further resources for primary prevention should be found, which would also enable children from all economic backgrounds to receive vaccination on an equal basis. Ideal reimbursement strategy would be full (100%) coverage by giving two doses for one or more cohorts. If it is not feasible second best option would be a partial reimbursement scheme for every child. In case it could not be reached, reimbursement only for risk groups should be implemented in Hungary (this is already available in Poland). As long-term evidence is not available at the time of registration, health economic modelling is required. Modelling with thorough sensitivity analysis can reduce the uncertainty of reimbursement decisions compared to alternative use of public resources.

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