Exploring the cost effectiveness of an immunization programme for rotavirus gastroenteritis in the United Kingdom

Abstract

Rotavirus is the most common cause of gastroenteritis in children aged <5 years old, two new vaccines have recently been developed which can prevent associated morbidity and mortality. While apparently safe and efficacious, it is also important to establish whether rotavirus immunization is cost effective. A decision analytical model which employs data from a review of published evidence is used to determine the cost effectiveness of a rotavirus vaccine. The results suggest that some of the health sector costs, and all of the societal costs, of rotavirus gastroenteritis in children can be avoided by an immunization programme. The additional cost to the health sector may be considered worthwhile if there is a sufficient improvement in the quality-of-life of children and parents affected by gastroenteritis; this study did not find any evidence of research which has measured the utility gains from vaccination.

A critical literature review of health economic evaluations of rotavirus vaccination

“…Although most studies suggest that the net costs of vaccination are positive, some concluded that vaccination is cost-saving from a societal perspective (Australia, 56 Belgium, 13 Italy, 29,30 UK, 39,41 and USA 73 ). However, the results of these studies were often contradicted by other results for the same countries.…”

“…However, the results of these studies were often contradicted by other results for the same countries. For example, for the UK, Largeron et al 39 and Lorgelly et al 41 predicted that vaccination would save £5700 (€5580) and £4.5 million (€4,34 million) respectively, from a societal perspective over 5 y, whereas Martin et al 42 predicted that vaccination would increase net costs by £33.4 million (€31.6 million) over 5 y from the TPP perspective. Net cost estimates from a TPP perspective in the UK ranged from £26.7 million (€25.8 million) 41 to £41.5 million (€40.6 million).…”

Pharmacoeconomic Spotlight on Rotavirus Vaccine RIX4414 (Rotarix™) in Developed Countries

“…In several analyses, both the healthcare payer and societal perspectives were used, [33][34][35][36][37][38][39][40] whereas other studies were conducted from either a societal [41,42] or a healthcare payer perspective. [43] Two studies adopted a 'limited societal' perspective, which excluded indirect costs but included out-ofpocket medical expenses along with other direct medical costs.…”

“…[44,45] Some studies focused only on RIX4414, [36,37,[42][43][44] while others also included indirect comparisons with the pentavalent rotavirus vaccine [34,35,38,39,41,45] or, in some cases, the universal rotavirus vaccination program being evaluated allowed for the use of either RIX4414 or the pentavalent rotavirus vaccine. [33,40,45] A wide range of results was reported across the cost-effectiveness analyses, which appears to be related, at least in part, to the substantial heterogeneity among the models used in the studies. The analyses typically showed that the cost of a universal rotavirus vaccination program was partly offset by reductions in RVGE-related healthcare resource use and that the program was associated with quality-adjusted life-year (QALY) gains.…”

“…The analyses typically showed that the cost of a universal rotavirus vaccination program was partly offset by reductions in RVGE-related healthcare resource use and that the program was associated with quality-adjusted life-year (QALY) gains. However, the universal rotavirus vaccination program was deemed to be cost effective from the perspective of the healthcare payer only in some studies, [36,37,42,43] but not in others, [33][34][35][38][39][40]43] when applying commonly reported cost-effectiveness thresholds, such as h20 000-50 000, $US50 000, or d20 000-30 000 per QALY gained. [46][47][48][49] A consistent finding across studies that were conducted from both a healthcare payer and a societal (or 'limited societal') perspective was that incremental cost-effectiveness ratios (ICERs) were more favorable from a societal perspective, [33][34][35][36][37][38][39][40]43] as might be expected because additional costs associated with RVGE (e.g.…”