Cost effectiveness of both (monovalent and pentavalent) rotavirus vaccines

Abstract

Objective: Rotavirus (RV) infections constitute a substantial burden in Turkey, particularly in children under 5 years of age. RV vaccines are administered to infants by payment only,and no reimbursement is available. The first aim of this study is to evaluate the cost effectiveness of implementing a national basis monovalent or pentavalent RV vaccination program in target populations.Material and Methods: A decision tree model was employed using demographic and epidemiological input obtained from study sources conducted before in our region and international literature. Monovalent or pentavalent vaccination was assumed to protect in 83.7% or 90% of severe RV acute gastroenteritis (RVAGE) in children respectively. Costs inputs were obtained from a provincial study conducted in 2007. Univariate sensitivity analyses and Monte-Carlo simulations were performed.Results: The vaccination program was cost effective and cost saving compared to no vaccination with 85% coverage. Monovalent and pentavalent RV vaccination led to a mean of 2,316 (95% CI: 2.240-2.392) and 2.972 (95% CI: 2.677-3.267) life-years gained (LYG) with 83.7% and 90% efficacy level respectively. Monovalent and pentavalent RV vaccinations avoided 551.820 (95% CI: 539.032; 564.609) and 683,529 (95% CI: 638.906-728.158) individuals with clinical acute gastroenteritis (AGE) cases requiring hospital visits respectively. In the simulation for monovalent and pentavalent vaccines, the cost of RVAGE was 116.1 million TL ((sic)59.2 million) in the non-vaccinated cohort and 35 and 22.5 million TL ((sic)17.8 and 11.5 million) in the vaccinated cohort respectively. The cost of the vaccination program was estimated to be approximately 65.6 and 83.4 million TL ((sic)33.5 and 42.5 million) and the incremental cost was approximately-15.4 million TL (-(sic)7.9 million) and -15.3 million TL(-(isc) 9.6 million) respectively.Conclusion: This analysis suggests that both monovalent and pentavalent RV vaccinations of children are very cost effective and also cost saving. Therefore, RV vaccination is associated with a positive return on investment from a public payers' perspective and supports the continued recommendation of RV vaccines as well as their full funding in Turkey.