EPIDEMIOLOGICAL AND ECONOMIC IMPACT OF MONOVALENT AND PENTAVALENT ROTAVIRUS VACCINES IN LOW AND MIDDLE INCOME COUNTRIES: A COST-EFFECTIVENESS MODELING ANALYSIS

Purpose: Competing choices of rotavirus vaccines make the selection of either vaccine difficult for health decision-makers. The objective of this study is to assess cost effectiveness of the monovalent and pentavalent rotavirus vaccines on children mortality in 116 low and middle income countries that represent ~99% of rotavirus mortality.

Method: A decision tree model follows hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases, and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year (DALY) averted, comparing no vaccination with either monovalent or pentavalent mass introduction. 

Result: Around 292 thousand deaths, 3.34 million inpatient cases, and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 60.8% of inpatient cases and 53.0% of deaths. Pentavalent vaccination would prevent 66.6% of inpatient cases and 57.6% of deaths. The vaccine was cost-effectiveness in all world countries in the base case scenario for both vaccines. Cost per DALY averted in all selected countries was I$203 for monovalent, and I$224 for pentavalent vaccination. 

Conclusion:

Rotavirus vaccine is cost-effective in all analyzed countries. Despite cost effectiveness analysis is a useful tool for decision making in middle income countries, for low income countries health-decision makers should also assess the impact of introducing either vaccine on local resources, and budget impact analysis of vaccination.