IS ONGOING ROTAVIRUS VACCINATION IN NORWAY COST-EFFECTIVE?

Purpose:   We aimed to re-assess the cost-effectiveness of ongoing rotavirus vaccination introduced in the Norwegian childhood immunization program in October 2014.

Method(s):   We used an age-structured dynamic transmission model to estimate the burden of rotavirus disease from 2015 to 2019, with and without vaccination. We assumed vaccine efficacy to be 93% against severe infection and 60% against symptomatic rotavirus infection. Using real-time immunization data, we modeled an increase in vaccination coverage after the program start from 77% in 2015 to 91% during 2016-2019. We evaluated a two-dose vaccination program with Rotarix® at a baseline cost of €24 per dose and a three-dose program with Rotateq® at a cost of €20 per dose. We developed an economic model to calculate costs and health effects of vaccination during the study period and estimated cost-effectiveness of the program in 2019 from a healthcare and societal perspective. We measured cost-effectiveness as cost per quality adjusted life year (QALY) using a threshold of €73,444 per QALY. Parameter uncertainty was accounted for using Monte Carlo methods. The estimates of vaccine price, disease burden, vaccine coverage, medical costs, production losses, QALY losses, and discount rate used in the model were varied in sensitivity analyses. 

Result(s):   During the first five years following vaccine introduction, rotavirus-associated deaths and hospitalizations are expected to be reduced by 67%, primary care consultations by 63%, and home care episodes by 57%. Vaccination was cost-effective from the healthcare perspective resulting in a cost of €1,379 per QALY for Rotarix® and €25,215 per QALY for Rotateq®. From the societal perspective, vaccination was found to be cost-saving resulting in €332,451 per QALY gained for Rotarix® and €308,615 per QALY gained for Rotateq®. Vaccination from a societal perspective remained cost-saving when productivity losses were reduced by 50%. Overall, vaccination resulted in an 82% reduction in rotavirus hospital costs, mainly due to avoided inpatient hospitalizations. A similar reduction (82%) was predicted for primary care costs. The cost-effectiveness of the program was most sensitive to changes in the estimated vaccine costs and QALY losses. 

Conclusion(s):   Ongoing rotavirus vaccination in Norway is cost-effective from both healthcare and societal perspectives, and is expected to reduce the burden of rotavirus disease considerably.