PIN72 Cost-Effectiveness of Rotavirus Immunization in Vietnam: Results and Challenges

Abstract

OBJECTIVES: To assess the cost-effectiveness of universal rotavirus immunization, explicitly the use of Rotateq® and affordability of implementing rotavirus immunization based on the Global Alliance for Vaccines and Immunization (GAVI)-subsidized vaccine price in the context of Vietnamese health care system for the next 5 years. METHODS: An age-structured cohort model was developed for the 2009 Vietnamese birth cohort and applied a 5-year time horizon with time cycle of 1 month for <1-year-old children and annually thereafter. Results from no vaccination and vaccination were compared. Outcomes included rotavirus episodes requiring home-treatment, outpatient visits, hospitalizations and deaths. Multiple outcomes per rotavirus infection are possible in the model. Acceptability and affordability analyses were done using Monte Carlo simulations. Costs were expressed in 2009 US$. RESULTS: Rotavirus immunization would not completely protect under-five-year-old children against rotavirus infection due to partial nature of vaccine immunity, however, would effectively reduce rotavirus severe cases by ∼55%. Under the GAVI-subsidized price, the minimum vaccination budget would be US$1.6 million annually. In the base-case, the incremental cost per quality- adjusted-life-year (QALY) was US$665 from health care perspective,-Vietnamese per-capita-GDP in 2009. Affordability results showed that at the GAVI-subsidized vaccine price, rotavirus vaccination could be affordable in Vietnam. CONCLUSIONS: Rotavirus immunization in Vietnam would be a cost-effective health intervention. However, it only becomes affordable under the GAVI's financial support. Vaccine price is the most crucial factor to decision-makers regarding introducing this vaccine into the country's immunization. Given the high underfive mortality rate, results showed that rotavirus immunization is the “best hope” for prevention of rotavirus-related diarrhoeal disease in Vietnam. In the next five years, Vietnam is definitely in debt to external financial support in implementing rotavirus vaccination. It is recommended that new and cheaper rotavirus vaccine candidates be developed to speed up rotavirus vaccines introduction in the developing world.