Hospitalization for acute cerebellitis in children affected by varicella: how much does it cost?

BACKGROUND: Chickenpox is a highly contagious airborne disease caused by the varicella zoster virus. It is generally benign and self-limiting, but it may be responsible of life-threatening complications. Acute cerebellitis (AC) is the most common neurological complication and is associated with prolonged hospitalization in the acute phase (HAP). AIM OF THE STUDY: To estimate the costs of AC HAP in children affected by varicella. MATERIALS AND METHODS: We retrospectively reviewed the medical records of a pediatric cohort hospitalized for chickenpox AC over a period of 15 years (from October 2003 to October 2018) and we analyzed acute care costs. For any patient the HAP has been calculated. The final value includes cost of hospital accommodation and management at the Pediatric and Infectious Diseases Unit. To this cost, the price of procedures (imaging, laboratory exams, medical and paramedical evaluations) and medical treatments was added. RESULTS: In the study period, 856 children had been hospitalized for varicella. Out of them, 65 met a diagnosis of AC and were included in the study. The hospitalization length was of 10 days (range 3-20 days). The median cost of HAP for each patient was of 5366 euro, with an average annual cost of 23,252 €. The most significant part of HAP is due to the cost of hospital accommodation and management at the Pediatric Infectious Diseases Unit, which was about € 537.78 for a single day. DISCUSSION: Although AC post-varicella is rare, its HAP cost is not negligible resulting in substantial economic burden. Vaccination would have probably prevented varicella and AC complication, avoiding hospitalization. CONCLUSIONS: Financial studies are important for evaluate the cost saving in order to influence public funding decisions. Further studies are necessary to investigate the economic burden of the disease.

Burden of herpes zoster: the direct and comorbidity costs of herpes zoster events in hospitalized patients over 50 years in France.

BACKGROUND: The objectives of this study were to describe hospital stays related to HZ and to evaluate the direct and indirect cost of hospitalizations due to HZ among patients aged over 50 years. METHODS: The hospitalizations of people aged over 50 years were selected from the French national hospital 2011 database (PMSI) using ICD-10 diagnosis codes for HZ. Firstly, stays with HZ as principal or related diagnostic were described through the patient characteristics, type of hospitalization and the related costs. Secondly, a retrospective case-control analysis was performed on stays with HZ as comorbidity in 5 main hospitalizations causes (circulatory, respiratory, osteo-articular, digestive systems and diabetes) to assess the impact of HZ as co-morbidity on the length of stay, mortality rate and costs. RESULTS: In the first analysis, 2,571 hospital stays were collected (60 % of women, mean age: 76.3 years and mean LOS: 9.5 days). The total health assurance costs were 10,8 M€. Mean cost per hospital stay was 4,206€. In the second analysis, a significant difference in LOS and costs was shown when HZ was associated as comorbidity in other hospitalization's causes. CONCLUSIONS: HZ directly impacts on the hospital cost. When present as comorbidity for other medical reasons, HZ significantly increases the length of hospital stay with subsequent economic burden for the French Health System.

[Chickenpox--neurological complications in children]. / Ospa wietrzna--powiklania ze strony osrodkowego ukladu nerwowego.

Chickenpox is one of the most common infectious diseases in children. In most of the cases the disease is mild and no complications of it are being observed. However, in some of the paediatric patients, the disease may have a serious course with different complications. Most of them are not life-threatening, but some of them, like myocarditis, hepatitis or thrombocytopenia, may be dangerous. Neurological complications of Varicella-zoster virus infection, like encephalitis, meningitis, transverse myelitis, cerebellitis, polyneuropathy or an ischemic stroke, are relatively rare. The authors present 5 children with different neurological complications of chickenpox. The neurological complications of chickenpox did not result in permanent sequel but the cost of hospitalization and the exclusion of the child from everyday activity seem to justify the idea of the routine vaccination.

An economic evaluation of varicella vaccination in Italian adolescents.

An economic evaluation was performed to assess five varicella vaccination scenarios targeted to 11-year-old Italian adolescents. The scenarios were: "compulsory vaccination" of all adolescents, recommended vaccination of susceptible adolescents on the basis of an "anamnestic screening", a "blood test" or a combination of both ("both tests") and vaccination of adolescents in the private sector, at the parents' charge ("private vaccination"). Probabilities and unit costs were taken from published sources and experts opinion. The accuracy of the anamnestic screening (81.6% sensitivity and 87.3% specificity) was derived from a separate descriptive study among 344 Italian adolescents. The costs and benefits of each scenario were simulated using a Markov model and cost-effectiveness, budget-impact and cost-benefit analyses were conducted. Of all considered scenarios, "both tests" and "anamnestic screening" were the most appealing options with an estimated net direct cost of 5058 and 8929 per life-year gained (compared to no vaccination) versus 14,693-42,842 for the other scenarios. These two scenarios further resulted in substantial net savings for society (over 600,000 per cohort, BCR: 2.17). The need for a serological confirmation was highly dependent on the sensitivity of the anamnestic screening, which is believed to increase once such a program is launched. For practical considerations, "anamnestic screening" seems to be the most convenient option.