Rotavirus vaccine cost-effective in Mexico?

29 Sep 2008

Paul Chinnock

Source: BMC Infectious Diseases (see original article or PDF)

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Citation: Valencia-Mendoza A, Bertozzi SM, Gutierrez JP, Itzler R (2008). Rotavirus vaccine cost-effective in Mexico? BMC Infect Dis; 29;8:103.

Diarrhoeal disease remains one of the biggest infectious killers worldwide. Most diarrhoeal deaths are in children in developing countries. In these countries, rotavirus is believed to be the leading cause of severe diarrhoea and diarrhoeal deaths in children under five years old.

A new pentavalent rotavirus vaccine (PRV) for the prevention of rotavirus gastroenteritis has been developed. Studies of its efficacy and safety have been encouraging. However, in low- and middle-income countries, the decision to add this vaccine to national immunisation programmes will depend heavily on its cost-effectiveness and affordability.

Valencia-Mendoza et al developed a cost-effectiveness model from the perspective of the Mexican health system, modelling the vaccination of a hypothetical birth cohort of two million children monitored from birth to 60 months of age. They compared the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Because the vaccine price has not yet been set by the manufacturer, the model used a range of possible prices from US $5 to $15 dollars per dose.

According to the model, including the pentavalent vaccine in Mexico’s national immunisation programme could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per three-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved.

The researchers conclude that at prices below $15 per dose, the cost per life-year saved is highly cost effective according to the criteria set by the WHO Commission on Macroeconomics and Health. The cost-effectiveness estimates are highly dependent upon mortality in the absence of the vaccine, which suggests that the vaccine is likely to be significantly more cost-effective among poorer populations and among those with less access to prompt medical care – such that poverty reduction programmes would be likely to reduce the future cost-effectiveness of the vaccine.

Whilst these are encouraging results, they are specific to one country, Mexico. Other countries considering the adoption of the rotavirus vaccine would be advised to develop their own national models. In addition, and as the authors of this paper note, the existence of a cost-effective vaccine in no way lessens the importance of other strategies for reducing diarrhoeal disease morbidity and mortality. These of course include improvements in water quality, nutrition and health care infrastructure, health education and the promotion of oral rehydration therapy.

2008 Valencia-Mendoza et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Source

Title:
Cost-effectiveness of introducing a rotavirus vaccine in developing countries: the case of Mexico.

Authors:
Valencia-Mendoza A, Bertozzi SM, Gutierrez JP, Itzler R

References:
BMC Infect. Dis. 2008: Vol. 8, pp. 103

Abstract:
BACKGROUND: In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. METHODS: A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. RESULTS: Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. CONCLUSION: At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be significantly more cost-effective among poorer populations and among those with less access to prompt medical care - such that poverty reduction programs would be expected to reduce the future cost-effectiveness of the vaccine.

PMID: 18664280
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