Varicella is a minor and self-limiting infection in children, yet it can consume a substantial amount of healthcare resources (HCRU). Charts were examined retrospectively among 1–14 year-olds to quantify/contrast varicella-associated HCRU in five middle-income countries where universal varicella immunisation was not adopted. Between 2009 and 2016, data on the management of primary varicella were collected, including outpatient/inpatient visits, allied healthcare contacts, tests/procedures, and medicines. These findings are compared across nations, and a regression model is fitted to projected country-level costs as a function of GDP.  There were 401 outpatients and 386 inpatients in total. Significant variations in the number of skin lesions among outpatients were reported among nations, ranging from 5.3 percent to 25.4 percent of patients with 250 lesions. The outcomes were less varied among inpatients. The average number of ambulatory medical visits ranged between 1.1 and 2.2. The average length of stay in the hospital ranged from 3.6 to 6.8 days. Except in Argentina, the use of tests/procedures was uncommon among outpatients; among inpatients, a test/procedure was ordered for 81.3 percent of patients, with no regional difference. Prescription medicines were given to 44.4 percent of outpatients and 86% of inpatients.

In the absence of immunisation, total projected cost on varicella treatment was forecasted using an exponential function based on income levels (GDP). This study shows that considerable HCRU is related with varicella, resulting in a major public health burden that might be reduced by using varicella vaccine. Differences in treatment recommendations, healthcare resource availability, and medical practises may explain reported differences between nations.