Potential impact and cost-effectiveness of rotavirus vaccination in Afghanistan

Palwasha Anwari,Frederic Debellut,Clint Pecenka,Sardar M Parwiz,Andrew Clark,Devin Groman,Najibullah Safi

doi:10.1016/j.vaccine.2017.10.058

Abstract

IntroductionDespite progress made in child survival in the past 20 years, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea. Rotavirus is responsible for more than a third of diarrhea deaths. In 2013, rotavirus was estimated to cause 215,000 deaths among children under five years, including 89,000 in Asia. As of April 2017, 92 countries worldwide have introduced rotavirus vaccination in their national immunization program. Afghanistan has applied for Gavi support to introduce rotavirus vaccination nationally. This study estimates the potential impact and cost-effectiveness of a national rotavirus immunization program in Afghanistan. MethodsThis study examined the use of Rotarix® (RV1) administered using a two-dose schedule at 6 and 10 weeks of age. We used the ProVac Initiative’s UNIVAC model (version 1.2.09) to evaluate the impact and cost-effectiveness of a rotavirus vaccine program compared with no vaccine over ten birth cohorts from 2017 to 2026 with a 3% annual discount rate. All monetary units are adjusted to 2017 US$. ResultsRotavirus vaccination in Afghanistan has the potential to avert more than one million cases; 660,000 outpatient visits; approximately 50,000 hospital admissions; 650,000 DALYs; and 12,000 deaths, over 10 years. Not accounting for any Gavi subsidy, rotavirus vaccination can avert DALYs at US$82/DALY from the government perspective and US$80/DALY from the societal perspective. With Gavi support, DALYs can be averted at US$29/DALY and US$31/DALY from the societal and government perspective, respectively. The average yearly cost of a rotavirus vaccination program would represent 2.8% of the total immunization budget expected in 2017 and 0.1% of total health expenditure. ConclusionThe introduction of rotavirus vaccination would be highly cost-effective in Afghanistan, and even more so with a Gavi subsidy.

Highlights

Despite progress made in child survival in the past 20 years, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea
To account for uncertainty, we looked at a high mortality scenario as well as a scenario accounting for a rotavirus mortality rate as low as 27.83 deaths per 100,000 per year in children under five years, as reported by Institute for Health Metrics and Evaluation (IHME) in Global Burden of Disease (GBD) 2015 [20]
The analysis was conducted by members of the Afghanistan National Immunization Technical Advisory Group and Ministry of Public Health (MoPH)

Summary

Introduction

Despite progress made in child survival in the past 20 years, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea. In 2013, rotavirus was estimated to cause 215,000 deaths among children under five years, including 89,000 in Asia. This study estimates the potential impact and cost-effectiveness of a national rotavirus immunization program in Afghanistan. Results: Rotavirus vaccination in Afghanistan has the potential to avert more than one million cases; 660,000 outpatient visits; approximately 50,000 hospital admissions; 650,000 DALYs; and 12,000 deaths, over 10 years. Despite a 53% reduction in the rate of all-cause mortality worldwide since 1990, 5.9 million children under five years died in 2015, with 9% of these deaths due to diarrhea [1]. In the most recent Global Burden of Disease (GBD) 2015 study, diarrheal diseases were the fourth leading cause of death among children under five years, responsible for 499,000 deaths, representing 8.6% of all deaths in this age group [2].

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Conclusion