Rotavirus Vaccination: Cost-Effectiveness and Impact on Child Mortality in Developing Countries

Atherly, Deborah
Dreibelbis, Robert
Parashar, Umesh D.
Levin, Carol
Wecker, John
Rheingans, Richard D.

¹PATH, Seattle, Washington; and ²Hubert Department of Global Health, Rollins School of Public Health, Emory University, and ³Viral Enteric Epidemiology Team, Division of Viral Diseases, National Centers for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta Georgia

Potential conflicts of interest: none reported

Financial support: none reported

Supplement sponsorship: This article was published as part of a supplement entitled “Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines,” which was prepared as a project of the Rotavirus Vaccine Program, a partnership between PATH, the World Health Organization, and the US Centers for Disease Control and Prevention, and was funded in full or in part by the GAVI Alliance

The views expressed by the authors do not necessarily reflect the views of the Rotavirus Vaccine Program, the GAVI Alliance, or the US Centers for Disease Control and Prevention

Reprints or correspondence: Dr. Deborah Atherly, PATH, 1455 NW Leary Way, Seattle, WA 98107 ([email protected])

Journal of Infectious Diseases 200:p S28-S38, November 1, 2009. | DOI: 10.1086/605033

Background

Rotavirus is the leading cause of severe gastroenteritis in children <5 years of age and is responsible for >500,000 deaths annually; ∼85% of this burden is in low-income countries eligible for financial support from the GAVI Alliance. We projected the uptake, health impact, and cost-effectiveness of introducing rotavirus vaccination in GAVI-eligible countries to help policy makers in prioritizing resources to gain the greatest health improvements for their constituencies

Methods

A demand forecast model was used to predict adoption of rotavirus vaccine in the poorest countries in the world. We then modeled health outcomes and direct costs of a hypothetical birth cohort in the target population for scenarios with and without a rotavirus vaccine with use of data on health outcomes of rotavirus infection, vaccine effectiveness, and immunization rates

Results

Vaccination would prevent 2.4 million rotavirus deaths and >82 million disability-adjusted life-years (DALYs) in 64 of the 72 GAVI-eligible countries introducing vaccine from 2007 through 2025. The cost per DALY averted decreases over time, from a high of US$450 per DALY averted in the first year to a sustained low of $30 per DALY during 2017–2025, with a cumulative figure of $43 per DALY averted during 2008–2025. By applying the baseline scenario with an initial vaccine price of $7 per dose for a 2-dose vaccine, with a gradual decrease beginning in 2012 and stabilizing at $1.25 per dose by 2017, vaccination was very cost-effective in all GAVI-eligible countries with use of each country's gross domestic product per DALY averted as a threshold

Conclusions

Introduction of rotavirus vaccines into the world's poorest countries is very cost-effective and is projected to substantially reduce childhood mortality