Abstract
BackgroundGlobally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).MethodsWe quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon.ResultsThe average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80–218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).ConclusionsThe combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.
Highlights
Diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden
We compared the current treatment of diarrhoea (using oral rehydration salt (ORS) and intravenous (IV) fluid), with the addition of rotavirus vaccination to the current diarrhoea treatment and with the provision of rotavirus vaccine (RV1) alone
60% and, in rural facilities, 39% of the total cost is used for purchase and distribution of vaccines
Summary
Diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. Diarrhoea is the second leading cause of morbidity and mortality globally among children below five years of age and is responsible for 23 million Disability Adjusted Life Years (DALYs) annually, about 10% of the total global childhood disease burden [1]. The introduction of integrated management of childhood illness (IMCI) more than two decades ago strengthened the Ruhago et al Cost Effectiveness and Resource Allocation (2015) 13:7 management of diarrhoea [6], with the adoption of oral rehydration solution (ORS) as a main intervention for diarrhoea treatment, recommended by World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) [7]. The recent emphasis on vertical programmes, targeting specific diseases such as Malaria, TB and HIV/AIDS, has led to reduced funding for IMCI and has weakened the management and control of diarrhoea [9]
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