Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis

Diop, Abdou K.; Atherly, Deborah; Faye, A.; Sall, Farba Lamine; Clark, Andrew; Nadiel, L; Yade, Binetou; Ndiaye, Mamadou Lamine; Cissé, Moussa; Ba, Mouhamadou Lamine

doi:10.1016/j.vaccine.2014.12.065

Cited by 15 publications

(21 citation statements)

References 40 publications

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“…If per capita income thresholds were applied using Bangladesh’s 2015 per capita GNI of $1190, rotavirus vaccination would be highly cost-effective in five of six scenarios, and cost-effective in the “low mortality, no Gavi subsidy” scenario [38]. This result is consistent with results from other low resource countries with a high rotavirus burden [11], [12], [13], [39]. Importantly, this analysis also demonstrates that rotavirus vaccination can be cost-effective outside of high mortality contexts and absent Gavi support.…”

Section: Discussionsupporting

confidence: 67%

“…The model is designed to be used at the country-level to conduct cost-effectiveness analyses for three vaccines: Rotavirus vaccine, Pneumococcal conjugate vaccine, and Haemophilus influenza type b and provides a consistent and transparent framework for comparing the impact and cost-effectiveness of these vaccines [10]. The model has been widely used across the world to evaluate the cost-effectiveness of these vaccines [11], [12], [13], [14], [15], [16]. The model input parameters include: demographics, burden of disease, vaccine schedule, vaccine efficacy, vaccine coverage, vaccine costs, health service utilization, and health service costs.…”

Section: Methodsmentioning

confidence: 99%

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Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Pecenka

Parashar

Tate

et al. 2017

Vaccine

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IntroductionDiarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners.MethodsThis analysis used Pan American Health Organization’s TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates.ResultsOver ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted.ConclusionThe discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination in Bangladesh.

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Section: Discussionsupporting

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Pecenka

Parashar

Tate

et al. 2017

Vaccine

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“…An adjustment factor for relative coverage was applied to the coverage estimates to account for the likelihood that children at the highest risk of dying from rotavirus disease are less likely to be vaccinated [ 50 ]. The inclusion of relative coverage in the CEAs increased over time (Fig.…”

Section: Resultsmentioning

confidence: 99%

Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries

Boujaoude

Mirelman

Dalziel

et al. 2018

Cost Eff Resour Alloc

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BackgroundCost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs between total health gains and equity impacts of interventions. This study investigates to what extent equity considerations have been taken into account in CEA in low- and middle-income countries (LMICs), using rotavirus vaccination as a case study.MethodsSpecific equity-related indicators for vaccination were first mapped to the Guidance on Priority Setting in Health Care (GPS-Health) checklist criteria. Economic evaluations of rotavirus vaccine in LMICs identified via a systematic review of the literature were assessed to explore the extent to which equity was considered in the research objectives and analysis, and whether it was reflected in the evaluation results.ResultsThe mapping process resulted in 18 unique indicators. Under the ‘disease and intervention’ criteria, severity of illness was incorporated in 75% of the articles, age distribution of the disease in 70%, and presence of comorbidities in 5%. For the ‘social groups’ criteria, relative coverage reflecting wealth-based coverage inequality was taken into account in 30% of the articles, geographic location in 27%, household income level in 8%, and sex at birth in 5%. For the criteria of ‘protection against the financial and social effects of ill health’, age weighting was incorporated in 43% of the articles, societal perspective in 58%, caregiver’s loss of productivity in 45%, and financial risk protection in 5%. Overall, some articles incorporated the indicators in their model inputs (20%) while the majority (80%) presented results (costs, health outcomes, or incremental cost-effectiveness ratios) differentiated according to the indicators. Critically, less than a fifth (17%) of articles incorporating indicators did so due to an explicit study objective related to capturing equity considerations. Most indicators were increasingly incorporated over time, with a notable exception of age-weighting of DALYs.ConclusionIntegrating equity criteria in CEA can help policy-makers better understand the distributional impact of health interventions. This study illustrates how equity considerations are currently being incorporated within CEA of rotavirus vaccination and highlights the components of equity that have been used in studies in LMICs. Areas for further improvement are identified.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0102-2) contains supplementary material, which is available to authorized users.

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“…Similarly, PATH led studies in AFR, complementing work previously conducted in other African countries. The current supplement showcases a more detailed description of AMP’s experience, as well as country-led publications from the three regions studied [5–12]. …”

Section: Methodsmentioning

confidence: 99%

Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group's experience

Jaúregui

García

Janusz

et al. 2015

Vaccine

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Introduction Pan American Health Organization’s (PAHO) ProVac Initiative aims to strengthen countries’ technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative’s tools and methods to support decisions in non-PAHO regions. Methods In 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. Results Fifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. Discussion Developing countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. Conclusion Decision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs.

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Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis

Cited by 15 publications

References 40 publications

Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Accounting for equity considerations in cost-effectiveness analysis: a systematic review of rotavirus vaccine in low- and middle-income countries

Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group's experience

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