Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study

Abstract

Background Previous studies have found rotavirus vaccination to be highly cost-effective in low-income countries. However, updated evidence is now available for several inputs (ie, rotavirus disease mortality rates, rotavirus age distributions, vaccine timeliness, and vaccine efficacy by duration of follow-up), new rotavirus vaccines have entered the market, vaccine prices have decreased, and cost-effectiveness thresholds have been re-examined. We aimed to provide updated cost-effectiveness estimates to inform national decisions about the new introduction and current use of rotavirus vaccines in Gavi countries.Methods We calculated the potential costs and effects of rotavirus vaccination for ten successive birth cohorts in 73 countries previously and currently eligible for Gavi support, compared with no vaccination. We used a deterministic cohort model to calculate numbers of rotavirus gastroenteritis cases, outpatient visits, hospitalisations, and deaths between birth and 5 years, with and without rotavirus vaccination. We calculated treatment costs from the government and societal perspectives. The primary outcome measure was the incremental cost-effectiveness ratio (discounted US$ per disability-adjusted life-year averted). Country-specific model input parameters were based on the scientific literature, published meta-analyses, and international databases. We ran deterministic and probabilistic uncertainty analyses.Findings Over the period 2018-27, rotavirus vaccination has the potential to prevent nearly 600 000 deaths in Gavi countries. Averted outpatient visits and hospitalisations could lead to treatment savings of approximately $484•1 million from the government perspective and $878•0 million from the societal perspective. The discounted dollars per disability-adjusted life-year averted has a very high probability (>90%) of being less than 0•5 times the gross domestic product per capita in 54 countries, and less than 1•0 times gross domestic product per capita in 63 countries.Interpretation Rotavirus vaccination continues to represent good value for money across most Gavi countries despite lower rotavirus mortality estimates and more stringent willingness-to-pay thresholds.Funding Bill & Melinda Gates Foundation.

The impact of maternal RSV vaccine to protect infants in Gavi-supported countries: Estimates from two models

“…Despite the differences in underlying model and the assumptions, our estimates are similar to the estimates of RSV MI impact in LMIC settings. Our results are also comparable with the projected impact of rotavirus vaccines, for instance, which are predicted to avert 36% of rotavirus-related diarrheal deaths among under 5 children across Gavi countries [30] . While the scale of RSV impact is smaller than that for other blockbuster vaccines, this is expected given the relative burden [31] .…”

Evaluating the potential economic and health impact of rotavirus vaccination in 63 middle-income countries not eligible for Gavi funding: a modelling study

“…We used UNIVAC (version 1.4.09), an Excel-based, deterministic proportionate outcomes model that has been used extensively for country-specific and global analyses. 6 , 14 , 17 , 18 , 19 , 20 , 21 …”

“…Methods for estimating rotavirus disease burden have been described in detail elsewhere. 6 , 14 The full list of country-specific data inputs and uncertainty ranges used to model disease burden is available in the appendix (pp 2–5 ).…”

“… 1 Rotavirus vaccines have been available to low-income and middle-income countries since 2009, and they are cost-effective in most settings, 2 , 3 , 4 , 5 a finding supported by a 2019 analysis of countries currently and previously supported by Gavi, the Vaccine Alliance. 6 …”

Knowledge and Attitudes Towards Rotavirus Diarrhea and the Acceptance of Rotavirus Vaccination Amongst Primary Caregivers in Yogyakarta, Indonesia: A Qualitative Study

“…To date, ninety-nine countries have introduced the vaccine, including 73 Gavi-eligible countries [14]. Rotavirus vaccination has the potential to prevent nearly 600 000 deaths and to save approximately $484•1 million from the government perspective and $878•0 million from the societal perspective [15]. A recent systematic review (2019) on rotavirus vaccines showed evidence of the vaccine's effectiveness in preventing death caused by rotavirus diseases and vaccine safety, both in developed and developing countries [16].…”