Economic Evaluation of Rotavirus Vaccination in Children Aged Under Five Years in South Africa
Ahmed Mohy,
Nicola Page,
Welekazi Boyce
et al.
Abstract:Background and Objective Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme. Methods Cost and cost-effectiveness analyses were… Show more
“…However, this is consistent with the WHO summary of prequalified rotavirus vaccines and was used in previous economic evaluations of rotavirus vaccines. 8 , 13 , 14 , 44 While a sensitivity or scenario analysis using differential vaccine estimates would be informative, the Roxette model used to conduct this analysis is built on the assumption that all vaccines would have equal efficacy in their complete dosing schedule and that a differential vaccine efficacy would arise from differential completion rates. However, this limitation can be expected to have minimal impact on the direction of the model results as the WHO reports comparable efficacy of the prequalified vaccines in high mortality settings for HRV (54%) and for HBRV and BRV-PV 1-dose vial (44%).…”
Section: Discussionmentioning
confidence: 99%
“…Briefly, a decision tree on disease management was added, comparing the costs and QALYs of vaccination both in the absence of the vaccines (natural disease pathway) and in the presence of the vaccines (intervention), as described previously. 13 , 14 The total costs and clinical outcomes associated with each vaccine were estimated and assessed in a feedback loop structure, as depicted in Figure 1 . Figure 1.…”
Section: Methodsmentioning
confidence: 99%
“…Four health states of rotavirus infection were used as described in previous modeling studies simulating rotavirus vaccination. 8 , 13 , 14 These four health states were: 1) RVGE home care (RVGE cases that can be treated at home without the need for healthcare provider consultation); 2) RVGE clinic visits (RVGE cases that require outpatient visits); 3) RVGE hospitalization (RVGE cases that require hospital admissions); 4) RVGE death. The outcomes used to measure the benefits of rotavirus vaccines in the model were expressed in the number of RVGE cases avoided and the accumulated Quality Adjusted Life Years (QALYs) by the birth cohort.…”
Section: Methodsmentioning
confidence: 99%
“…These costs are summarized in Table S2 and have been described in detail previously. 13 The waste disposal cost was estimated as $163.5 per m 3 of wasted vaccine. Vaccine administration costs were calculated per minute of healthcare worker time, summarized in Table S3.…”
Following the introduction of rotavirus vaccination into the Moroccan National Immunization Program, the prevalence of the disease has decreased by nearly 50%. However, evidence on the economic value of rotavirus vaccinations in Morocco is limited. This health economic analysis evaluated, from both country payer and societal perspectives, the costs and the cost-effectiveness of three rotavirus vaccines using a static, deterministic, population model in children aged < 5 years in Morocco. Included vaccines were HRV (2-dose schedule), HBRV (3-dose schedule) and BRV-PV 1-dose vial (3-dose schedule). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The model predicted that vaccination with HRV was estimated to result in fewer rotavirus gastroenteritis events (−194 homecare events, −57 medical visits, −8 hospitalizations) versus the 3-dose vaccines, translating into 7 discounted quality-adjusted life years gained over the model time horizon. HRV was associated with lower costs versus HBRV from both the country payer (−$1.8 M) and societal (−$4.1 M) perspectives, and versus BRV-PV 1-dose vial from the societal perspective (−$187,000), dominating those options in the cost-effectiveness analysis. However, costs of BRV-PV 1-dose vial were lower than HRV from the payer perspective, resulting in an ICER of approximately $328,376 per QALY, above the assumed cost effectiveness threshold of $3,500. Vaccination with a 2-dose schedule of HRV may be a cost-saving option and could lead to better health outcomes for children in Morocco versus 3-dose schedule rotavirus vaccines.
“…However, this is consistent with the WHO summary of prequalified rotavirus vaccines and was used in previous economic evaluations of rotavirus vaccines. 8 , 13 , 14 , 44 While a sensitivity or scenario analysis using differential vaccine estimates would be informative, the Roxette model used to conduct this analysis is built on the assumption that all vaccines would have equal efficacy in their complete dosing schedule and that a differential vaccine efficacy would arise from differential completion rates. However, this limitation can be expected to have minimal impact on the direction of the model results as the WHO reports comparable efficacy of the prequalified vaccines in high mortality settings for HRV (54%) and for HBRV and BRV-PV 1-dose vial (44%).…”
Section: Discussionmentioning
confidence: 99%
“…Briefly, a decision tree on disease management was added, comparing the costs and QALYs of vaccination both in the absence of the vaccines (natural disease pathway) and in the presence of the vaccines (intervention), as described previously. 13 , 14 The total costs and clinical outcomes associated with each vaccine were estimated and assessed in a feedback loop structure, as depicted in Figure 1 . Figure 1.…”
Section: Methodsmentioning
confidence: 99%
“…Four health states of rotavirus infection were used as described in previous modeling studies simulating rotavirus vaccination. 8 , 13 , 14 These four health states were: 1) RVGE home care (RVGE cases that can be treated at home without the need for healthcare provider consultation); 2) RVGE clinic visits (RVGE cases that require outpatient visits); 3) RVGE hospitalization (RVGE cases that require hospital admissions); 4) RVGE death. The outcomes used to measure the benefits of rotavirus vaccines in the model were expressed in the number of RVGE cases avoided and the accumulated Quality Adjusted Life Years (QALYs) by the birth cohort.…”
Section: Methodsmentioning
confidence: 99%
“…These costs are summarized in Table S2 and have been described in detail previously. 13 The waste disposal cost was estimated as $163.5 per m 3 of wasted vaccine. Vaccine administration costs were calculated per minute of healthcare worker time, summarized in Table S3.…”
Following the introduction of rotavirus vaccination into the Moroccan National Immunization Program, the prevalence of the disease has decreased by nearly 50%. However, evidence on the economic value of rotavirus vaccinations in Morocco is limited. This health economic analysis evaluated, from both country payer and societal perspectives, the costs and the cost-effectiveness of three rotavirus vaccines using a static, deterministic, population model in children aged < 5 years in Morocco. Included vaccines were HRV (2-dose schedule), HBRV (3-dose schedule) and BRV-PV 1-dose vial (3-dose schedule). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The model predicted that vaccination with HRV was estimated to result in fewer rotavirus gastroenteritis events (−194 homecare events, −57 medical visits, −8 hospitalizations) versus the 3-dose vaccines, translating into 7 discounted quality-adjusted life years gained over the model time horizon. HRV was associated with lower costs versus HBRV from both the country payer (−$1.8 M) and societal (−$4.1 M) perspectives, and versus BRV-PV 1-dose vial from the societal perspective (−$187,000), dominating those options in the cost-effectiveness analysis. However, costs of BRV-PV 1-dose vial were lower than HRV from the payer perspective, resulting in an ICER of approximately $328,376 per QALY, above the assumed cost effectiveness threshold of $3,500. Vaccination with a 2-dose schedule of HRV may be a cost-saving option and could lead to better health outcomes for children in Morocco versus 3-dose schedule rotavirus vaccines.
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