Health and economic impact of rotavirus vaccination in GAVI-eligible countries

Abstract

BackgroundRotavirus infection is responsible for about 500,000 deaths annually, and the disease burden is disproportionately borne by children in low-income countries. Recently the World Health Organization (WHO) has released a global recommendation that all countries include infant rotavirus vaccination in their national immunization programs. Our objective was to provide information on the expected health, economic and financial consequences of rotavirus vaccines in the 72 GAVI support-eligible countries.MethodsWe synthesized population-level data from various sources (primarily from global-level databases) for the 72 countries eligible for the support by the GAVI Alliance (GAVI-eligible countries) in order to estimate the health and economic impact associated with rotavirus vaccination programs. The primary outcome measure was incremental cost (in 2005 international dollars [I$]) per disability-adjusted life year (DALY) averted. We also projected the expected reduction in rotavirus disease burden and financial resources required associated with a variety of scale-up scenarios.ResultsUnder the base-case assumptions (70% coverage), vaccinating one single birth cohort would prevent about 55% of rotavirus associated deaths in the 72 GAVI-eligible countries. Assuming I$25 per vaccinated child (~$5 per dose), the number of countries with the incremental cost per DALY averted less than I$200 was 47. Using the WHO's cost-effectiveness threshold based on per capita GDP, the vaccines were considered cost-effective in 68 of the 72 countries (~94%). A 10-year routine rotavirus vaccination would prevent 0.9-2.8 million rotavirus associated deaths among children under age 5 in the poorest parts of the world, depending on vaccine scale-up scenarios. Over the same intervention period, rotavirus vaccination programs would also prevent 4.5-13.3 million estimated cases of hospitalization and 41-107 million cases of outpatient clinic visits in the same population.ConclusionsOur findings suggest that rotavirus vaccination would be considered a worthwhile investment for improving general development as well as childhood health level in most low-income countries, with a favorable cost-effectiveness profile even under a vaccine price ($1.5-$5.0 per dose) higher than those of traditional childhood vaccines.

Cost-Effectiveness of Haemophilus influenzae Type b Conjugate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assessment of Major Determinants

“…38–42 It is important to note that the unique purpose of these global analyses is not to provide accurate cost-effectiveness estimates for a given country, but to give an indication of what the plausible range of cost-effectiveness is likely to be for countries in a particular region/income strata, and to identify the most important determinants of cost-effectiveness for those countries. An alternative approach could have been to run the analysis for all countries separately, as in the studies by Kim et al and Goldie et al 39,42 However, this level of disaggregation could be misleading because a number of country-specific estimates are generated without any primary data collection. If cost-effectiveness estimates are to have any real influence on decision-making at country-level, countries need to have ownership over the data, assumptions, and results of the model.…”

Public finance of rotavirus vaccination in India and Ethiopia: An extended cost-effectiveness analysis

“…Rotavirus vaccination may be a very cost-effective intervention [9], [10], [11], [12], [13] and [14] which could save up to 2.5 million lives over the next 20 years in Global Alliance for Vaccines and Immunization(GAVI)-eligible countries [10]. Countryspecific benefits from rotavirus vaccination will depend on the specific burden of diarrhea, vaccine price and efficacy, and the targeting of the vaccination programs [9], [12] and [13].…”

Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries

“…[1][2][3][4][5] This is the first study that assesses competing choices of rotavirus vaccines and is a significant update to previous reports because new evidence on diarrheal burden of disease has recently emerged. The most important finding of our study shows that rotavirus vaccination is justified in most world countries.…”

“…Although those previous analyses have shown that rotavirus vaccination is costeffective in some low-income and middle-income countries, [1][2][3][4][5] no study has attempted to highlight possible differences in costeffectiveness for these 2 vaccines. Also, new rotavirus vaccines are in development, showing promising preliminary results.…”

“…[1][2][3][4][5] Around 200,000-500,0000 rotavirus-related deaths were estimated worldwide in 2008. 6 Two effective and safe rotavirus vaccines have been approved by drug agencies around the world to diminish this burden.…”