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Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Thursday, 31st of August 2017

Full text is at http://www.sciencedirect.com/science/article/pii/S0264410X17307570?via%3Dihub

Vaccine. 2017 Jul 13;35(32):3982-3987. doi: 10.1016/j.vaccine.2017.05.087. Epub 2017 Jun 13.

Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Pecenka C¹, Parashar U², Tate JE², Khan JAM³, Groman D⁴, Chacko S⁵, Shamsuzzaman M⁶, Clark A⁷, Atherly D⁴.

Author information

1

PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA. Electronic address: cpecenka@path.org.

2

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.

3

Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom.

4

PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.

5

WHO Country Office, 10 Gulshan Avenue, Gulshan-1, Dhaka 1212, Bangladesh.

6

National Immunization Program of Bangladesh, Directorate General of Health Services (DGHS), EPI Bhaban, Mohakhali, Dhaka 1212, Bangladesh.

7

London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.

Abstract

INTRODUCTION:

Diarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners.

METHODS:

This analysis used Pan American Health Organizations TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates.

RESULTS:

Over ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted.

CONCLUSION:

The discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination in Bangladesh.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.