Abstract
BackgroundRotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. New rotavirus vaccines have recently been approved. Some previous studies have provided broad qualitative insights into the health and economic consequences of introducing the vaccines into low-income countries, representing several features of rotavirus infection, such as varying degrees of severity and age-dependency of clinical manifestation, in their model-based analyses. We extend this work to reflect additional features of rotavirus (e.g., the possibility of reinfection and varying degrees of partial immunity conferred by natural infection), and assess the influence of the features on the cost-effectiveness of rotavirus vaccination.MethodsWe developed a Markov model that reflects key features of rotavirus infection, using the most recent data available. We applied the model to the 2004 Vietnamese birth cohort and re-evaluated the cost-effectiveness (2004 US dollars per disability-adjusted life year [DALY]) of rotavirus vaccination (Rotarix®) compared to no vaccination, from both societal and health care system perspectives. We conducted univariate sensitivity analyses and also performed a probabilistic sensitivity analysis, based on Monte Carlo simulations drawing parameter values from the distributions assigned to key uncertain parameters.ResultsRotavirus vaccination would not completely protect young children against rotavirus infection due to the partial nature of vaccine immunity, but would effectively reduce severe cases of rotavirus gastroenteritis (outpatient visits, hospitalizations, or deaths) by about 67% over the first 5 years of life. Under base-case assumptions (94% coverage and $5 per dose), the incremental cost per DALY averted from vaccination compared to no vaccination would be $540 from the societal perspective and $550 from the health care system perspective.ConclusionIntroducing rotavirus vaccines would be a cost-effective public health intervention in Vietnam. However, given the uncertainty about vaccine efficacy and potential changes in rotavirus epidemiology in local settings, further clinical research and re-evaluation of rotavirus vaccination programs may be necessary as new information emerges.
Highlights
Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children
Human rotavirus infections are characterized by the following features: (1) diverse genotypes that vary geographically and over time [3,4,5]; (2) frequently asymptomatic presentation or non-specific clinical symptoms; (3) agedependency of clinical manifestation [6]; (4) common reinfections and varying degrees of protection against subsequent infections depending on the number of previous infections [7,8]; and (5) seasonality of incidence [9]
With 94% vaccination coverage, approximately 47% of children would get infected with rotavirus before age 5, and the incidence of severe cases of rotavirus gastroenteritis would be reduced by about 67%
Summary
Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. New rotavirus vaccines have recently been approved. Some previous studies have provided broad qualitative insights into the health and economic consequences of introducing the vaccines into low-income countries, representing several features of rotavirus infection, such as varying degrees of severity and age-dependency of clinical manifestation, in their model-based analyses. Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among children under 5 years of age [1,2]. The rotavirus infection is reported to cause more than 2 million hospitalizations and about 527,000 deaths annually (as of 2004), and the burden of disease is higher in developing countries [1]. Three studies have evaluated the impact of introducing rotavirus vaccines in low-income countries in Asia (one each in Vietnam [13], Uzbekistan [15], and Asia as a whole [14]) where the burden of rotavirus disease is greatest
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