Benefits Of Rotavirus Vaccination Research Articles

Cost-effectiveness of rotavirus vaccination in the Philippines: A modeling study

IntroductionRotavirus gastroenteritis (RVGE) remains a leading cause of hospitalization and death in children under five years of age in the Philippines. Rotavirus (RV) vaccination was introduced into the national immunization program (NIP) in 2012 but has since been limited to one region due to cost considerations and conflicting local cost-effectiveness estimates. Updated estimates of the cost-effectiveness of RV vaccination are required to inform prioritization of national immunization activities. MethodsWe calculated the potential costs and benefits of rotavirus vaccination over a 10-year-period (2021–2031) from a government and societal perspective, comparing four alternative rotavirus vaccines: Rotavac, Rotasiil, Rotarix and Rotateq. For each vaccine, a proportionate outcomes model was used to calculate the expected number of disease events, DALYs, vaccination program costs, and healthcare costs, with and without vaccination. The primary outcome measure was the cost per DALY averted. Assuming each product would generate similar benefits, the dominant (lowest cost) product was identified. We then calculated the cost-effectiveness (US$ per Disability Adjusted Life Year [DALY] averted) of the least costly product and compared it to willingness-to-pay thresholds of 0.5 and 1 times the national GDP per capita ($3,485), and ran deterministic and probabilistic sensitivity analyses. ResultsIntroducing any of the four rotavirus vaccines would avert around 40% of RVGE visits, hospitalizations, and deaths over the period 2021–2031. Over the same ten-year period, the incremental cost of vaccination from a government perspective was estimated to be around $104, $105, $220, and $277 million for Rotavac, Rotasiil, Rotarix and Rotateq, respectively. The equivalent cost from a societal perspective was $58, $60, $178 and $231 million. The cost-effectiveness of the least costly product (Rotavac) was $1,148 ($830–$1682) from a government perspective and $646 ($233–1277) from a societal perspective. All other products offered similar benefits but at a higher cost. There is a >99% probability that Rotavac would be cost-effective at a willingness-to-pay threshold set at 0.5 times the national GDP per capita. ConclusionBoth Rotavac and Rotasiil are likely to be cost-effective options in the Philippines, but it is not possible to say definitively which product should be preferred. Rotarix and Rotateq are expected to offer similar benefits at more cost, so would need to be priced far more competitively to be considered for introduction.

Quantitative Benefit-Risk Models Used for Rotavirus Vaccination: A Systematic Review.

BackgroundAlthough rotavirus vaccines have proven to prevent the risk of rotavirus gastroenteritis (RVGE) in children under 5 years old, they are also associated with an increased transient risk of intussusception (IS). Several quantitative benefit-risk models (qBRm) are performed to measure this balance in hospitalizations and deaths prevented versus the ones induced.MethodIn this study, our objective was to provide a complete overview of qBRm used for rotavirus vaccination. We systematically searched 3 medical literature databases to identify relevant articles, in English, that were published between 2006 and 2019.ResultsOf the 276 publications screened, 14 studies using qBRm for rotavirus vaccination were retained, based on preselected criteria. Four were performed in low- and middle-income countries. Almost all (13 of 14) displayed the following characteristics: force of infection assumed to be constant over time (static model), indirect effect of rotavirus vaccination (herd effect) not considered, closed model (individuals not allowed to enter and/or exit the model over time), and aggregated level (no tracking of individual’s behavior). Most of the models were probabilistic (9 of 14) and reported sensitivity and/or scenario analyses (12 of 14). Input parameter values varied across studies. Selected studies suggest that, depending on the models used, for every IS hospitalization and death induced, vaccination would prevent, respectively, 190–1624 and 71–743 RVGE-related hospitalizations and deaths.ConclusionsThe benefits of rotavirus vaccination were shown to largely exceed the increased risk of IS, across all studies. Future research aiming to harmonize qBRm for rotavirus vaccination should ensure the comparability of studies and provide additional information for regulatory authorities, physicians, and patients.

Introduction of rotavirus vaccination in Palestine: An evaluation of the costs, impact, and cost-effectiveness of ROTARIX and ROTAVAC.

IntroductionThe Palestinian Ministry of Health (MOH) started a routine rotavirus immunization program with ROTARIX in May 2016, with support for vaccine procurement and introduction provided through a global development organization. In 2018, financial responsibility for rotavirus vaccine procurement was transferred to the Palestinian government, which elected to shift to ROTAVAC vaccine because of its lower price per dose. This study aims to assess the cost, impact, and cost-effectiveness of rotavirus vaccination, specifically evaluating the economic implications of the change in vaccine product, accounting for the different characteristics of each rotavirus vaccine used.MethodsWe conducted primary and secondary data collection to assess the introduction, procurement, supply chain, and service delivery costs related to each vaccine. We used the UNIVAC model to project costs and benefits of rotavirus vaccination over a 10-year period comparing the use of ROTARIX versus no vaccination; ROTAVAC versus no vaccination; and ROTAVAC versus ROTARIX. We undertook scenario and probabilistic analyses to capture uncertainty in some of the study parameters. We used a 3% discount rate, and all costs are in 2018 US$.ResultsThe cost to deliver one dose was lower for ROTAVAC than ROTARIX (US$2.36 versus $2.70), but the total cost per course, excluding vaccine cost, favored ROTARIX ($7.09 versus $5.39). Both vaccines had high probability of being cost-effective interventions in Palestine compared to no vaccine. Because of lower vaccination program costs for ROTAVAC, however, switching from ROTARIX to ROTAVAC was cost-saving.ConclusionNational decision-makers should consider systematically assessing multiple criteria beyond vaccine price when comparing the health and economic value of several products in order to fully account for all characteristics including product presentation, number of doses per course, cold chain volume, cost of delivery, and wastage.

PIN115 - BARRIERS TO ACCESS AND IMPLEMENTATION OF ROTAVIRUS VACCINATION IN EUROPE

Rotavirus (RV) is a major agent of gastroenteritis and an important cause of child death worldwide. Immunization has been available since 2006. (1) Twelve years after the authorization of two rotavirus vaccines of demonstrated efficacy and with a strongly positive benefit-risk profile, implementation in Europe remains low. The aim of this study is to review existing barriers to access and implementation of RV vaccination in Europe. A literature search using online electronic databases was conducted to collect information on national and local recommendations, costs and perception of barriers for implementation of RV vaccination in Europe. Relevant scientific articles published between 2010 and 2018 were included in the review. Some key factors have been identified as existing barriers to vaccine access and implementation. The direct and indirect costs for vaccination and the limited perception of RV severity by the families are two major barriers for large-scale implementation of RV vaccination programs in Europe. Insufficient information and lack of public awareness on the benefits of RV vaccination may lead to negative perceptions among the general public. However, some authorities may restrict access due to the wrong perception of disease burden. Among the other identified barriers are: economic assessment of universal RV vaccination, cost-effectiveness of RV vaccination, funding of RV vaccination, and safety issues. Decentralized systems are expected to see less access and implementation of RV vaccines. Negative public perceptions on the necessity of RV vaccines could be serious barriers to access and use of RV vaccines in the studied countries. The implementation of RV vaccines is still low. Barriers to implementation vary according to settings. Nevertheless, public health authorities should promote greater public engagement and education for health-care providers on vaccination benefits in order to implement RV vaccination.

Intussusception after monovalent rotavirus vaccine—United States, Vaccine Adverse Event Reporting System (VAERS), 2008–2014

BackgroundIn 2006 and 2008, two new rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) were introduced in the United States. US data on intussusception have been mostly related to RV5, with limited data on RV1. MethodsWe assessed intussusception events following RV1 reported to the Vaccine Adverse Event Reporting System (VAERS), a US national passive surveillance system, during February 2008–December 2014. We conducted a self-controlled risk interval analysis using Poisson regression to estimate the daily reporting ratio (DRR) of intussusception after the first 2 doses of RV1 comparing average daily reports 3–6 versus 0–2 days after vaccination. We calculated the excess risk of intussusception per 100,000 vaccinations based on DRRs and background rates of intussusception. Sensitivity analyses were conducted to assess effects of differential reporting completeness and inaccuracy of baseline rates. ResultsVAERS received 108 confirmed insusceptible reports after RV1. A significant clustering was observed on days 3–8 after does1 (p=0.001) and days 2–7 after dose 2 (p=0.001). The DRR comparing the 3–6 day and the 0–2 day periods after RV1 dose 1 was 7.5 (95% CI=2.3, 24.6), translating to an excess risk of 1.6 (95% CI=0.3, 5.8) per 100,000 vaccinations. The DRR was elevated but not significant after dose 2 (2.4 [95% CI=0.8,7.5]). The excess risk ranged from 1.2 to 2.8 per 100,000 in sensitivity analysis. ConclusionsWe observed a significant increased risk of intussusception 3–6 days after dose 1 of RV1. The estimated small number of intussusception cases attributable to RV1 is outweighed by the benefits of rotavirus vaccination.

Intussusception After Rotavirus Vaccines Reported to US VAERS, 2006–2012

In 2006 and 2008, 2 new rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) were introduced in the United States. We assessed intussusception events reported to the Vaccine Adverse Event Reporting System from February 2006 through April 2012 for RV5 and from April 2008 through April 2012 for RV1. For RV5, we conducted a self-controlled risk interval analysis using Poisson regression to estimate the daily reporting ratio (DRR) of intussusception comparing average daily reports 3 to 6 versus 0 to 2 days after vaccination. We calculated reporting rate differences based on DRRs and background rates of intussusception. Sensitivity analyses were conducted to assess effects of differential reporting completeness and inaccuracy of baseline rates. Few reports were submitted after RV1, allowing only a descriptive analysis. The Vaccine Adverse Event Reporting System received 584 confirmed intussusception reports after RV5 and 52 after RV1, with clustering 3 to 6 days after both vaccines. The DRR comparing the 3- to 6-day and the 0- to 2-day periods after RV5 dose 1 was 3.75 (95% confidence interval = 1.90 to 7.39). There was no significant increase in reporting after dose 2 or dose 3. Over all 3 doses, the excess risk of intussusception was 0.79 events (95% confidence interval = -0.04 to 1.62) per 100 000 vaccinations. From the sensitivity analyses, we conclude that under a worst-case scenario, the DRR could be 5.00 and excess risk per 100 000 doses could be 1.36. We observed a persistent clustering of reported intussusception events 3 to 6 days after the first dose of RV5 vaccination. This clustering could translate to a small increased risk of intussusception, which is outweighed by the benefits of rotavirus vaccination.

Intussusception Risk and Health Benefits of Rotavirus Vaccination in Mexico and Brazil

Intussusception Risk and Health Benefits of Rotavirus Vaccination in Mexico and Brazil

Unexpected Benefits of Rotavirus Vaccination in the United States

The large-scale introduction of a new vaccine can uncover many secrets and surprises about the epidemiology of disease that might not be discovered in any other way. Examination of the outcome of a vaccine introduction can validate prior assumptions concerning the burden of disease and the economic consequences of the vaccination program, as well as determine herd effects of the program arising from either a reduction in the environmental load of the infectious agent or a decrease in the group of susceptibles that might blunt transmission of the agent. In this issue of the Journal, Lopman et al document the impact of the introduction of rotavirus vaccines in the United States and find some surprises that could not have been fully anticipated or predicted in advance [ 1 ]. In 2006, the United States introduced a new rotavirus vaccine that was immediately recommended for the routine immunization of all children [ 2 ]. Uptake was slow at first but by 2008, about 60% of American infants were being immunized. Small local surveys of diarrheal illnesses in children , 2y ears who had been immunized indicated a substantial reduction in hospitalizations and emergency room visits [ 3 ‐ 8 ], outcomes predicted by the large clinical trials that determined the vaccine’s efficacy to be 85% or more against severe disease [ 9 , 10 ]. However, this was not the whole story. Lopman et al at the Centers for Disease Control and Prevention have analyzed al arge database covering approximately 20% of all US hospital admissions and looked at the numbers of discharges coded for diarrhea due to rotavirus or for any unspecified cause among children from 0 to 24 years of age. They compared baseline rates of these hospital discharge records in the prevaccination years, 2000‐2006, versus the postvaccination year 2008, as well as the trend over the 2-year period when the vaccine was being introduced. From this analysis, they have made several remarkable observations on the indirect effects of the vaccine that could not have been anticipated before the vaccine was introduced.