Economic Impact of a Rotavirus Vaccine in Brazil

Abstract

The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$ 7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio.

A systematic review of health economic evaluations of vaccines in Brazil

“…18,23,29 Sixteen of the 20 articles (80%) were published in international journals; 5 in scientific journals specialized in vaccines, 4 in public health journals, 5 in infectious diseases journals. Only 2 of them were published in health economics specialized journals, and one in medical informatics journal.…”

“…13,14,30 Indirect effects of the vaccination program (herd protection) was considered in 40% (8/ 20) of the reviewed studies: in 5 studies, which assessed HPV (2 studies), varicella, hepatitis A and dengue vaccination programs, 19,[26][27][28]32 the indirect effects were captured in the base case analysis by a dynamic model; and in 3 studies that assessed childhood pneumococcal conjugate vaccination using statistic decision tree model, the indirect protection was evaluated in a secondary or sensitivity analysis. [21][22][23] Six studies did not take indirect protection into account 14,17,18,24,25,29 and 6 did not inform. 13,15,16,20,30,31 Table 2 and Table 3 present the main methodological characteristics of the selected articles.…”

“…1), 20 were full HEEs that dealt with vaccines, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] all them published between 1995 and 2013. Figure 2 shows the growth in the number of HEEs on vaccines published in the period.…”

“…15 Thirteen studies (65%) presented the incremental HEE: health economic evaluation cost-effectiveness ratio (ICER). [17][18][19][21][22][23][24][25][26][27][28][29]31 One study presented the net benefit, 14 and another presented cost difference. 13 Based on WHO proposed criteria for cost-effectiveness to interpret the studies' results, 11 considering the 13 studies that reported ICERs, the vaccination strategy was cost-saving in 3 studies; the ICER was <1 per capita gross domestic product (GDP) per DALY, considered as very cost-effective, in 7 studies; and the ICER was between 1 and 3 GDP/DALY, considered cost-effective, in 3 studies.…”

“…Six studies (30%) were funded by the pharmaceutical industry, 14,18,[21][22][23][24] 6 (30%) by the government and research funding agencies, 17,19,25,[28][29][30] and 3 (15%) were financed by research institutes. 15,31,32 Conflict of interest was reported in 35% (7/20) of the studies; 5 articles reported having conflict of interest.…”