Abstract
BackgroundIn Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. MethodsTo assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. ResultsOur model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. DiscussionOur data will guide Bolivia's funding allocation for RV as international subsidies change.
Highlights
Rotavirus is the leading cause of severe gastroenteritis among children under five years of age and is globally responsible for an estimated 111 million episodes of diarrhea requiring home care, 25 million clinic visits, 2 million hospitalizations, and as many as 592,000 deaths annually [1, 2]
Rotavirus vaccination (RV) reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea
We estimated the five-year cumulative risk for hospitalization and outpatient care due to rotavirus disease based on administrative data from the National Statistics Institute of Bolivia [63], the 2003 birth cohort (251,000 consistent through 2009) [64], and data on the proportion of these events due to rotavirus, as identified by the National Rotavirus Surveillance Program (NRSP) in Bolivia (Table 1)
Summary
Rotavirus is the leading cause of severe gastroenteritis among children under five years of age and is globally responsible for an estimated 111 million episodes of diarrhea requiring home care, 25 million clinic visits, 2 million hospitalizations, and as many as 592,000 deaths annually [1, 2]. Estimates of the economic burden of rotavirus diarrhea vary substantially by country [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. The break-even price of the vaccine, defined as the price at which vaccination costs equal the costs saved by the health system, ranged from US$0.18 in low-income Asian countries [6] to US$54 USD in Taiwan [57]. Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program
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