The objective is to estimate the hypothetical benefits of immediate introduction of rotavirus vaccination for infants in the Netherlands as from 2006, reflecting the lost opportunity. An age-structured, deterministic cohort-model was used to simulate different birth cohorts over the 14 years 2006–2020, comparing both universal and targeted high-risk group vaccination versus no vaccination. Different scenarios for the duration of protection (5 or 7 years), herd-immunity (only for universal vaccination), and time-horizon (lifetime or maximum of 14 years) were analyzed. The total evaluated birth cohorts included 4.5 million infants, of which 7.9% were high-risk individuals, and an additional 13.2 million children between 1-15 years born prior to the first cohort in 2006. The costs and health outcomes associated with rotavirus vaccination were calculated per scenario and discounted at 4% and 1.5%, respectively. Rotavirus vaccination would have resulted in an estimated reduction of 356,800 cases (51% decrease) and 32,200 cases (5% decrease) for universal and targeted vaccination, respectively. Both the universal and targeted vaccination approach could have led to a decrease of 30 deaths, and 1,390 (+47%) and 560 QALYs (+19%) gained with universal and targeted vaccination, respectively. Hypothetical cost-offsets for universal and targeted rotavirus vaccination were estimated at €98 million (-82%) and €17 million (-14%) costs saved, and 1,390 (+47%) and 560 (+19%) QALYs gained with universal and targeted vaccination respectively. Additionally, including the cases prevented due to herd protection would even result in more QALYs gained and greater cost-savings. Our analysis reveals that had the rotavirus vaccine been implemented immediately after EMA authorization, it would have led to a significant amount of rotavirus cases avoided, QALYs gained and costs saved over the last 14 years. Universal vaccination including subsequent herd-immunity effects resulted in most favorable outcomes.
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