Abstract
BackgroundRotavirus gastroenteritis (RVGE) is a frequent disease in young children. The recommended German paediatric immunisation schedule does not currently include rotavirus vaccination. A lack of economic data on the impact of routine vaccination is stated as one of the reasons. As a result, the current coverage rate is low, around 26%. This study investigated whether rotavirus vaccination using the two-dose rotavirus vaccine RIX4414 (Rotarix®, GlaxoSmithKline Vaccines) would be a cost-saving intervention from the perspective of the statutory health insurance (SHI) in Germany.ObjectiveThe objective of the study was to analyse health outcomes (number of RVGE cases and hospitalisations prevented) and the associated cost to the SHI when comparing 100% rotavirus vaccination with no vaccination in Germany.MethodsA Markov cohort model simulated the number of RVGE events and related costs in a German birth cohort over the first 60 months of life with current disease management. The model compared an unvaccinated cohort with a fully vaccinated cohort. Vaccine efficacy data from international clinical trials were combined with German-specific epidemiological and cost data. Results were tested using extensive sensitivity analyses.ResultsFull vaccination of a birth cohort against rotavirus disease would be expected to prevent 82% of RVGE cases, reducing RVGE frequency from 28 to 5 events per 100 children in the birth cohort up to age 5 years. The estimated cost reduction with vaccination for that period is predicted to be €9.2 million with 100% coverage (€6.9 million with 75% coverage), mainly due to reductions in SHI reimbursement for productivity losses, hospital stays and visits to office-based physicians due to the vaccine’s efficacy against severe disease.ConclusionsRoutine rotavirus vaccination in Germany would reduce the number of hospitalised and outpatient cases. The associated investment could be fully offset by costs avoided in hospital stays, physician visits and SHI reimbursement of productivity losses. Sensitivity analysis indicated that vaccination would be cost-saving in 95% of simulations. Incremental cost was observed only under extreme conditions, especially when the time spent at home due to rotavirus disease was low or when vaccine efficacy against severe disease was heavily decreased.
Highlights
Rotavirus gastroenteritis (RVGE) is a frequent disease in young children
The associated investment could be fully offset by costs avoided in hospital stays, physician visits and statutory health insurance (SHI) reimbursement of productivity losses
Incremental cost was observed only under extreme conditions, especially when the time spent at home due to rotavirus disease was low or when vaccine efficacy against severe disease was heavily decreased
Summary
Rotavirus gastroenteritis (RVGE) is a frequent disease in young children. Rotavirus is the leading cause of acute gastroenteritis (AGE) in young children [1,2]. In the European Union rotavirus is estimated to cause more than 200 deaths each year, over 87,000 hospital admissions, and almost 700,000 outpatient visits in children under the age of 5 years [7]. The burden of the disease in Germany is well documented through epidemiological surveys [1,8,9,10], cost-of-illness studies [11,12], and a family impact study [13]. According to the Robert Koch Institute, RVGE is the most frequent registered disease in children aged
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