Tuesday, October 20, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Kristian Samdal, MPhil1, Gunhild Hagen, MPhil1, Elmira Flem, MD, MPH2 and Marianne Klemp Gjertsen, MD, PhD3, (1)Norwegian Knowledge Centre for the Health Services, Oslo, Norway, (2)Norwegian Institute of Public Health, Oslo, Norway, (3)University of Oslo, Oslo, Norway
Purpose: To estimate the cost-effectiveness of including rotavirus vaccination in the childhood immunization programme in Norway.
Methods: We performed a cost-utility analysis from a health care perspective by developing a Markov model that followed a hypothetical birth cohort of 60,000 children from birth to 5 years of age. The model compared the costs and effects of vaccination with Rotarix® and Rotateq® to an unvaccinated cohort. The input variables in the model included data on rotavirus disease burden, costs of rotavirus infection, parameters of vaccine efficacy, and impact on the quality of life associated with rotavirus infection. Data on the disease burden were based on a prospective surveillance study of rotavirus hospitalizations in three major hospitals in Norway. Economic data were expressed in EUROs (€), and included vaccine price, vaccine administration costs, costs of rotavirus-associated hospitalizations and outpatient visits. The cost estimates were based on pharmacy pricelists, tariffs from the Norwegian Medical Association, DRG-weights, and expert opinion. Data on vaccine efficacy were obtained from randomized controlled trials and evaluated in meta-analyses, while impact on the quality of life was obtained from the literature. The effectiveness was expressed in quality adjusted life-years (QALY). The model was developed using the TreeAge® software. We estimated the incremental cost-effectiveness ratios (ICER) per QALY gained compared to a non-vaccination program. The model will later be expanded to include indirect costs, and sensitivity analyses.
Results: Rotavirus infection is estimated to cause approximately 900 rotavirus hospitalizations, 7,200 outpatient visits and 28,900 home care episodes annually in Norway, amounting to approximately € 1,239,000 per year in direct medical costs. In the baseline analysis, vaccination with Rotarix® yielded an ICER of € 93,450 per QALY gained compared to non-vaccination. Vaccination with Rotateq® provided an ICER of € 104,400. However, when costs per hospitalization avoided were considered, cost-effectiveness with Rotateq® was more favourable than with Rotarix® at approximate costs of € 4910 and € 4980, respectively.
Conclusions: Using € 40,000 per QALY as a threshold for cost-effectiveness, rotavirus vaccination is not considered cost-effective from a health care perspective in Norway under the assumptions applied. However, vaccination may become cost-effective if indirect costs are included. The analysis using a societal perspective is needed to fully examine the cost-effectiveness of rotavirus vaccination in Norway.
Candidate for the Lee B. Lusted Student Prize Competition
