Abstract
BackgroundEach year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands. While two vaccines against rotavirus are registered, routine immunisation of infants has not yet been implemented. Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. We aimed to investigate which factors had a major impact on cost-effectiveness and were primarily responsible for the large differences in previously estimated cost-effectiveness ratios.MethodsBased on updated data on health outcomes and cost estimates, we re-assessed the cost-effectiveness of routine paediatric rotavirus vaccination within the National Immunization Program for the Netherlands. Two consensus meetings were organised with national and international experts in the field to achieve consensus and resolve potential controversies.ResultsIt was estimated that rotavirus vaccination in the Netherlands could avert 34,214 cases of rotavirus gastroenteritis in children aged less than 5 years. Notably, 2,779 hospitalisations were averted of which 315 were extensions of existing hospital stays due to nosocomial rotavirus infection. With a threshold varying from 20K€ - 50K€ per QALY and according to the base-case scenario, the full vaccination costs per child leading to cost-effectiveness was €57.76 -€77.71. Results were sensitive to the inclusion of potential vaccine induced herd protection, QALY losses and number of deaths associated with rotavirus gastroenteritis.ConclusionsOur economic analysis indicates that inclusion of rotavirus vaccination in the Dutch National Immunization Program might be cost-effective depending on the cost of the vaccine and the impact of rotavirus gastroenteritis on children's quality of life.
Highlights
Each year rotavirus gastroenteritis results in thousands of paediatric hospitalisations and primary care visits in the Netherlands
Outcomes in our analysis were classified by severity and included home-treated community-acquired diarrhoea and RV infection leading to consultation of a general practitioner (GP) and/or hospital admissions, nosocomial infections and death
We investigated the impact of including the quality-adjusted life year (QALY) decrements based on either the Canadian or the UK estimates, and the impact of including non-ageor sex weighted disability-adjusted life years (DALYs) rather than QALYs based on the study by Mangen et al [9]
Summary
Existing cost-effectiveness studies showed inconsistent results for these vaccines because of lack of consensus on the impact. While in Western countries mortality due to diarrhoea is low, a high level of morbidity has led scientific societies (ESPID and ESPGHAN) to recommend the introduction of universal mass vaccination with rotavirus vaccines to all Western European infants and children [4,5]. Over the last few years, four different studies were performed to assess the cost-effectiveness of routine infant RV vaccination in the Netherlands, and reported inconsistent and varying results [7,8,9,10]. Goossens et al concluded that mass vaccination against rotavirus gastroenteritis (RVGE) can be attractive from both an economic and a health care point of view, while a more recent paper by Mangen et al stated that vaccination cannot be considered cost-effective [7,9]. Though the four studies focused on either one or both of the two registered vaccines
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