Re-evaluating the cost and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi

A comparison of three rotavirus vaccines

Clint Pecenka, Frederic Debellut, Naor Bar-Zeev, Palwasha Anwari, Justice Nonvignon, Md Shamsuzzaman, Andrew Clark

Research output: Contribution to journalArticle

Abstract

Introduction: Diarrhea is a leading cause of mortality worldwide and rotavirus accounts for many of these deaths. As of August 2018, 96 countries have introduced rotavirus vaccines into their immunization programs. Two rotavirus vaccines, Rotarix® and RotaTeq®, have been WHO-prequalified since 2009, with Rotarix® being the preferred product of most Gavi-supported countries. ROTAVAC® and ROTASIIL® have both been prequalified recently. Materials and methods: We reevaluated the costs and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi and compared Rotarix®, ROTAVAC®, and ROTASIIL® in each country. For consistency with previously published analyses in these countries, we used the same Excel-based cohort model and much of the same data as the original analyses. We varied the expected price (with and without Gavi subsidy), wastage, and incremental health system costs associated with each vaccine. We assumed the same efficacy and waning assumptions following administration of two or three doses for the respective product. Results: The discounted cost per DALY averted compared to no vaccination ranged from 0.3 to 1.3 times GNI per capita for each vaccine. With the Gavi subsidy, the average cost-effectiveness ratios were below 0.3 times GNI per capita in all three countries. Though critical empirical cost data are not yet available, Rotarix® is the least costly and most cost-effective product in the countries examined in this modelling study. However, small decreases in the incremental health system cost for other products could result in cost and cost-effectiveness outcomes that match or surpass those of Rotarix®. Conclusion: Countries may wish to consider new rotavirus vaccines entering the market. Countries should carefully examine multiple product attributes including price and the incremental health system costs associated with each vaccine. These costs will vary by country and may be a defining factor in determining the least costly and most cost-effective product for the population.

Original languageEnglish (US)
Pages (from-to)7472-7478
Number of pages7
JournalVaccine
Volume36
Issue number49
DOIs
StatePublished - Nov 26 2018

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Rotavirus Vaccines
Malawi
Ghana
Bangladesh
Rotavirus
cost effectiveness
Cost-Benefit Analysis
Vaccination
vaccination
vaccines
Costs and Cost Analysis
Health Care Costs
subsidies
Vaccines
Immunization Programs
diarrhea
immunization
Diarrhea
death
markets

Keywords

  • Cost-effectiveness
  • Gavi countries
  • New vaccine introduction
  • Rotavirus vaccines

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Re-evaluating the cost and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi : A comparison of three rotavirus vaccines. / Pecenka, Clint; Debellut, Frederic; Bar-Zeev, Naor; Anwari, Palwasha; Nonvignon, Justice; Shamsuzzaman, Md; Clark, Andrew.

In: Vaccine, Vol. 36, No. 49, 26.11.2018, p. 7472-7478.

Research output: Contribution to journalArticle

Pecenka, Clint ; Debellut, Frederic ; Bar-Zeev, Naor ; Anwari, Palwasha ; Nonvignon, Justice ; Shamsuzzaman, Md ; Clark, Andrew. / Re-evaluating the cost and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi : A comparison of three rotavirus vaccines. In: Vaccine. 2018 ; Vol. 36, No. 49. pp. 7472-7478.
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AB - Introduction: Diarrhea is a leading cause of mortality worldwide and rotavirus accounts for many of these deaths. As of August 2018, 96 countries have introduced rotavirus vaccines into their immunization programs. Two rotavirus vaccines, Rotarix® and RotaTeq®, have been WHO-prequalified since 2009, with Rotarix® being the preferred product of most Gavi-supported countries. ROTAVAC® and ROTASIIL® have both been prequalified recently. Materials and methods: We reevaluated the costs and cost-effectiveness of rotavirus vaccination in Bangladesh, Ghana, and Malawi and compared Rotarix®, ROTAVAC®, and ROTASIIL® in each country. For consistency with previously published analyses in these countries, we used the same Excel-based cohort model and much of the same data as the original analyses. We varied the expected price (with and without Gavi subsidy), wastage, and incremental health system costs associated with each vaccine. We assumed the same efficacy and waning assumptions following administration of two or three doses for the respective product. Results: The discounted cost per DALY averted compared to no vaccination ranged from 0.3 to 1.3 times GNI per capita for each vaccine. With the Gavi subsidy, the average cost-effectiveness ratios were below 0.3 times GNI per capita in all three countries. Though critical empirical cost data are not yet available, Rotarix® is the least costly and most cost-effective product in the countries examined in this modelling study. However, small decreases in the incremental health system cost for other products could result in cost and cost-effectiveness outcomes that match or surpass those of Rotarix®. Conclusion: Countries may wish to consider new rotavirus vaccines entering the market. Countries should carefully examine multiple product attributes including price and the incremental health system costs associated with each vaccine. These costs will vary by country and may be a defining factor in determining the least costly and most cost-effective product for the population.

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