PIN16 Cost-Effectiveness of Rotavirus Immunization in Indonesia Taking Breastfeeding Patterns Into Account

Abstract

OBJECTIVES: This study aims to assess the cost-effectiveness of rotavirus immunization in Indonesia, taking breastfeeding patterns explicitly into account. METHODS: An age-structured cohort model was developed for the 2011 Indonesia birth cohort. Next, we compared two strategies, the current situation without rotavirus immunization versus the alternative of a national program. The model applies a 5 years time horizon, with 1 month analytical cycles for children less than 1 year of age and annual cycles beyond 1 year. Four scenarios were compared: population under 1 year old with 100% exclusive breastfeeding, 100% partial breastfeeding, 100% no breastfeeding and the actual combination over the different breastfeeding modes as present in Indonesia currently. Monte Carlo simulations were used to examine the economic acceptability and affordability of the rotavirus vaccination. RESULTS: Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of life. Under the GAVI-subsidized vaccine price the vaccine cost would amount to US$ 3.7 million per annum. The incremental cost per quality-adjusted-life-year (QALY) in the base case was US$ 271 from health care perspective; much lower than the Gross Domestic Product (GDP) per capita of US$ 3.469 in 2011. Affordability results showed that at the GAVI-subsidized vaccine price, rotavirus vaccination could be affordable for the Indonesian health system. Vaccination is most cost-effective in case of 100% no breastfeeding. CONCLUSIONS: Rotavirus immunization in Indonesia would be a cost-effective health intervention with GAVI's financial support. The results showed that rotavirus immunization would greatly reduce the burden of disease due to rotavirus. It also showed that no breastfeeding would make vaccination the most cost-effective intervention comparing to other two breastfeeding patterns.