Purpose: In the middle income country Kazakhstan, rotavirus infections represent a major cause of morbidity and mortality among children. Health authorities consider including rotavirus vaccination in the national childhood vaccination program.
Methods: We adapted a previously published dynamic compartemental model of rotavirus infection. The model was calibrated to available sentinel data of hospitalized rotavirus cases in children < 5 years using a maximum likelihood approach. The model estimates the number of fatalities, hospitalizations, outpatient clinic visits and homecare cases. Based on published cost data and the market price of vaccine ($43 per dose) we estimated the health consequences, costs and cost per life year gained from 20 years of vaccination in a societal and health care perspective. We varied the onset of vaccine effect (2-4-6 months) vaccine coverage (20%-100%) using 4 months and 90% in the base case. Uncertainty was further evaluated by means of probabilistic sensitivity analysis.
Results: In the base case, 20 year of vaccination will entail 1,110 avoided fatalities, 65,000 hospitalizations, 480,000 doctor visits and 2.5 million home care cases with birth cohorts of approximately 300,000 (undiscounted). In the health care perspective, the discounted cost per life year gained was $19,200 which is higher than GDP/capita in Kazakhstan ($12,700). This cost was almost uninfluenced by the vaccination rate, but was a linear function of the vaccine price. When including indirect costs of morbidity and mortality, vaccination is cost-saving.
Conclusion: In a middle income country, rotavirus vaccination results in great impact on morbidity and mortality. The crucial factors of the cost-effectiveness analysis were the purchasing price of the vaccine and the perspective of the analysis.
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