Will vaccination against rotavirus infection with RIX4414 be cost-saving in Germany?

Abstract

BackgroundRotavirus gastroenteritis (RVGE) is a frequent disease in young children. The recommended German paediatric immunisation schedule does not currently include rotavirus vaccination. A lack of economic data on the impact of routine vaccination is stated as one of the reasons. As a result, the current coverage rate is low, around 26%. This study investigated whether rotavirus vaccination using the two-dose rotavirus vaccine RIX4414 (Rotarix®, GlaxoSmithKline Vaccines) would be a cost-saving intervention from the perspective of the statutory health insurance (SHI) in Germany.ObjectiveThe objective of the study was to analyse health outcomes (number of RVGE cases and hospitalisations prevented) and the associated cost to the SHI when comparing 100% rotavirus vaccination with no vaccination in Germany.MethodsA Markov cohort model simulated the number of RVGE events and related costs in a German birth cohort over the first 60 months of life with current disease management. The model compared an unvaccinated cohort with a fully vaccinated cohort. Vaccine efficacy data from international clinical trials were combined with German-specific epidemiological and cost data. Results were tested using extensive sensitivity analyses.ResultsFull vaccination of a birth cohort against rotavirus disease would be expected to prevent 82% of RVGE cases, reducing RVGE frequency from 28 to 5 events per 100 children in the birth cohort up to age 5 years. The estimated cost reduction with vaccination for that period is predicted to be €9.2 million with 100% coverage (€6.9 million with 75% coverage), mainly due to reductions in SHI reimbursement for productivity losses, hospital stays and visits to office-based physicians due to the vaccine’s efficacy against severe disease.ConclusionsRoutine rotavirus vaccination in Germany would reduce the number of hospitalised and outpatient cases. The associated investment could be fully offset by costs avoided in hospital stays, physician visits and SHI reimbursement of productivity losses. Sensitivity analysis indicated that vaccination would be cost-saving in 95% of simulations. Incremental cost was observed only under extreme conditions, especially when the time spent at home due to rotavirus disease was low or when vaccine efficacy against severe disease was heavily decreased.

Economic evaluation of pediatric influenza immunization program compared with other pediatric immunization programs: A systematic review

“…2009 34 CEA (1) Immunisation(2) No immunisation US NHSSocietal < 5 y 75% 20 y Cases averted & QALY Direct and indirect (2007, US$) One-wayModel sensitive to coverage and vaccine efficacy Cost/QALY: £69,886Cost/averted case: £51.91 RV Atkins et al. 2012 35 CEA (1) Immunisation(2) No immunisation EW NHS < 5 y 95% 50 y QALY Direct costs (2010–11, £) One-way & PSAModel sensitive to the vaccine price, immunity waning and vaccine administration cost Cost/QALY: Static model (without herd immunity)Cost saving - £21,077 (£45/ course)£9,313 – 35,711 (£60/course)Dynamic model (with herd immunity)Cost-saving - £13,267 (£45/course)£6,841 – 27,901 (£60/course) RV Knoll et al. 2013 36 CEA (1) Immunisation(2) No immunisation DE SHI Birth cohort 100% 5 y Cases averted and savings Direct and indirect (2011, €) One-way & PSAModel sensitive to the frequency of seeking medical advice, RV disease and hospital visits Net saving: >£9 million RV Imaz et al.…”

“…Studies on RV immunisation strategies 28–37 primarily followed birth cohorts for up to 5 years across 29,30,35–37 various perspectives including statutory health insurance (SHI) 35,37 and regional health service (RHS). 31 Cost per QALY and cases averted were the most common effectiveness measures provided.…”

The Economic Value of Rotavirus Vaccination When Optimally Implemented in a High-Income Country

“…The initial economic assessment of rotavirus vaccines, published around the period of approval and launch in Europe in 2006, used a static Markov cohort model as a reference, published by Melliez et al [ 52 ] and applied to Belgium [ 29 ] and many other countries in Europe (including the UK [ 40 ], France [ 2 ], Italy [ 53 ], the Netherlands [ 54 ], and Germany [ 55 ]). The evaluation was performed as if the vaccine was assessed after a period of vaccine uptake where the at-risk population (children ≤ 5 years old) was followed from birth until the age of 5 years (the at-risk period).…”