One of the main causes of acute gastroenteritis in children under 5 years of age is rotavirus infection (RVI). Vaccines against RVI significantly reduce the incidence. Aim. To evaluate the cost-effectiveness of mass vaccination of children with a 5-valent RVI vaccine in the Russian Federation. Materials and methods. The assessment was carried out using modeling based on published data on the effectiveness of the vaccine and epidemiological indicators in the Russian Federation. The analysis was carried out from the perspective of the health care system and society as a whole with a 5-year horizon. The cost of RVI therapy corresponded to the compulsory health insurance tariffs for St. Petersburg for 2022, the price of 1 dose of the vaccine was the registered price, including VAT. Costs and life expectancy, taking into account quality, were discounted at 3.5 % per year. Results. Given the assumptions made, routine vaccination will prevent an average of 468,637 cases of RVI over 5 years. Avoided direct medical costs, i. e. RVI treatment costs will amount to 53,4 %, and lost income due to temporary disability – 46,6 % of the total avoided costs. At the same time, the volume of avoided costs is 61,4 % due to a decrease in morbidity in the vaccinated population, and 38.6 % due to the development of a indirect effect. The predicted avoided costs per 1 vaccinated person is 2,975 thousand rubles. From a societal perspective, the cost-effectiveness of the Rota-V-Aid vaccine will be 364,813 thousand rubles / QALY (quality-adjusted life year), and from a healthcare perspective – 1726,399 thousand rubles / QALY. Thus, in both cases, the cost-effectiveness of RVI vaccination will not exceed the generally accepted threshold of willingness to pay, equal to three times the gross domestic product per capita in the Russian Federation (according to data for 2021 – ~2,7 million rubles). The predicted cost-effectiveness of selective vaccination is significantly lower than that of mass vaccination. Conclusions. Mass vaccination of children with a 5-valent vaccine against RVI will not only reduce the incidence in the Russian Federation, but, taking into account the assumptions made, can also be considered as a cost-effective intervention.
The work objective was to carry out the analysis of the existing in the Russian Federation monitoring of the incidence of new coronavirus infection in children and specific features of death cases caused by COVID-19 in children. Materials and methods. The analysis of the data of operative statistics presented on the sites of the governments of the regions where the incidence among children was considered within the period from April 22, 2020 to June 26, 2020, as well as the data of the Main non-staff experts in infectious diseases in children was performed. The inpatient medical documentation and the data of pathologicoanatomic investigation of children died due to COVID-19 were analyzed. Results. Prevalence of COVID-19 in children from various regions of the Russian Federation was from 1% to 8.6% in the structure of general disease incidence. The asymptomatic and mild forms of the disease which did not require hospitalization, were noted in 55–60% of the cases. 12 death cases associated with COVID-19 were registered for June 22, 2020. The analysis of 8 presented cases showed that 6 patients out of 8 died children were of the first half of the year of life (3 girls and 5 boys). In most cases the children were admitted to the hospital at the 8–12th day of the disease in severe and extremely severe condition due to pulmonary-cardiac insufficiency, six patients had fever up to 38–39°С, four patients had signs of consciousness depression. All children were diagnosed with community-acquired bilateral pneumonia according to the data of roentgenography, ultrasound investigation or computer tomography of the chest organs that did not always coincide with the intensity of respiratory syndrome. The direct cause of death was cardiac or pulmonary-cardiac insufficiency. Conclusion. The analysis of clinical and laboratory manifestations of COVID-19 with an unfavourable outcome in children revealed some difficulties in the interpretation of its role in thanatogenesis. The significance of comorbid pathologies in the development of unfavourable outcomes is doubtless.
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