Rotavirus-coded Deaths in Children, United States, 1999–2007

Desai, Rishi; Esposito, Doug; Lees, Christine H.; Goodin, Kate; Harris, Meg; Blostein, Joel; Parashar, Umesh D.

doi:10.1097/inf.0b013e318220fe20

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Furthermore, we observed RV mortality exclusively among patients with any of these high-risk conditions. Although absolute numbers were low, similar observations in other European and US studies and the association between diarrhea-related mortality and birth weight confirm the existence of differential mortality risks [17,19,30-32]. Of note, in five out of seven patients who succumbed the underlying illness rather than RV was stated as the cause of death in death-records.…”

Section: Discussionsupporting

confidence: 84%

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Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal vaccination

Bruijning-Verhagen

Mangen

Felderhof

et al. 2013

BMC Med

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BackgroundThe cost-effectiveness of universal rotavirus (RV) vaccination is controversial in developed countries. As a result, RV vaccination programs do not currently exist in most European countries. Hospitalization is the main driver of RV disease costs, and prematurity, low birth weight (LBW) and underlying medical conditions have been associated with RV hospitalization and complications. We investigated the cost-effectiveness of targeted RV vaccination of high-risk infants and universal RV vaccination versus no vaccination.MethodsDisease burden, mortality and healthcare costs of RV hospitalization for children with and without prematurity, LBW and congenital pathology were quantified in two hospital-based observational studies in the Netherlands. Cost-effectiveness analysis was based on an age-structured stochastic multi-cohort model of the Dutch population comparing universal RV vaccination and targeted vaccination of high-risk infants to no vaccination. The primary endpoint was the incremental cost-effectiveness ratio (ICER), with a threshold of €35,000/quality-adjusted life year (QALY) from the healthcare provider perspective. Sensitivity analyses included vaccine price and coverage, herd-immunity and QALY losses.ResultsA total of 936 children with RV infection were included. Prematurity, LBW and congenital pathology were associated with increased risks of RV hospitalization (relative risks (RR) ranging from 1.6 to 4.4), ICU admission (RR ranging from 4.2 to 7.9), prolonged hospital stay (1.5 to 3.0 excess days) and higher healthcare costs (€648 to €1,533 excess costs). Seven children succumbed due to RV complications, all belonging to the high-risk population. Targeted RV vaccination was highly cost-effective and potentially cost-saving from the healthcare provider perspective with ICERs below €20,000/QALY in all scenarios with total (undiscounted) annual healthcare costs between -€0.1 and €0.5 million/year. Results were most sensitive to mortality rates, but targeted vaccination remained highly cost-effective up to reductions of 90% compared to observed mortality. Universal RV vaccination was not considered cost-effective (mean ICER: €60,200/QALY) unless herd-immunity and caretaker QALY losses were included and vaccine prices were €60 at most (mean ICER: €21,309/QALY).ConclusionWe recommend targeted RV vaccination for high-risk infants in developed countries.

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Section: Discussionsupporting

confidence: 84%

“…Moreover, these children are more prone to complicated RV disease courses with more frequent ICU admission [18]. RV infection in premature or LBW infants has been associated with necrotizing enterocolitis, encephalopathy [25-29] and increased diarrheal mortality [30-32]. …”

Section: Introductionmentioning

confidence: 99%

Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal vaccination

Bruijning-Verhagen

Mangen

Felderhof

et al. 2013

BMC Med

View full text Add to dashboard Cite

show abstract

“…First, the rotavirus code has been shown to be specific for identifying rotavirus laboratory-confirmed hospitalizations; however, rotavirus-coded events underestimate the true burden of rotavirus hospitalizations, because laboratory testing and coding for rotavirus are not routinely performed for all patients with gastroenteritis [16,17]. This is particularly true for rotavirus mortality trends, which have been documented in the prevaccine era but not in the postvaccine years [18]. Additionally, aggregate deidentified patient data preclude analyses by vaccination status.…”

Section: Discussionmentioning

confidence: 99%