Impact and cost-effectiveness of rotavirus vaccination in Bangladesh

Abstract

IntroductionDiarrheal 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.MethodsThis analysis used Pan American Health Organization’s 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.ResultsOver 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.ConclusionThe 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.

Re-evaluating the cost and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi: A comparison of three rotavirus vaccines

“…The authors recently undertook impact and cost-effectiveness analyses of rotavirus vaccination in Bangladesh, Ghana, and Malawi [13] , [14] , [15] . Each analysis used the TRIVAC model, a static cohort model developed at the London School of Hygiene and Tropical Medicine with support from the Pan American Health Organization’s ProVac Initiative.…”

“…In this analysis, we reevaluate cost-effectiveness studies previously conducted in Bangladesh, Ghana, and Malawi [13] , [14] , [15] . Our objective is to compare the economic impacts of three vaccines (Rotarix®, ROTAVAC®, and ROTASIIL®) as though they were all available at the time of the original analyses.…”

Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings

“…Wastage costs were included to account for drugs compromised by heat, expiry date, breakage and wear and tear. Wastage rates for injectable oxytocin and misoprostol were modelled at 5% based on studies of medical ampoule wastage rates [44]. For inhaled oxytocin, a higher wastage rate (7%) was assumed based on expert opinion that the inhaler may be discarded at a slightly higher rate than the oxytocin ampoule due incorrect use of the device (Table 5).…”

Potential Impact and Cost-Effectiveness of Rotavirus Vaccination in Afghanistan

“…We assumed vaccine efficacy for the two-dose schedule to be 53.1% and a single dose was conservatively assumed to provide half that efficacy [15,24]. We assumed rates of waning vaccine-induced protection consistent with the waning observed in the trial.…”