Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study

Summary: Background: Previous studies have found rotavirus vaccination to be highly cost-effective in low-income countries. However, updated evidence is now available for several inputs (ie, rotavirus disease mortality rates, rotavirus age distributions, vaccine timeliness, and vaccine efficacy by...

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Main Authors: Frédéric Debellut, MSc, Andrew Clark, PhD, Clint Pecenka, PhD, Jacqueline Tate, PhD, Ranju Baral, PhD, Colin Sanderson, ProfPhD, Umesh Parashar, MD, Laura Kallen, MPH, Deborah Atherly, PhD
Format: Article
Language:English
Published: Elsevier 2019-12-01
Series:The Lancet Global Health
Online Access:http://www.sciencedirect.com/science/article/pii/S2214109X19304395
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spelling doaj-6f5baad8df9f4752af8e78115c67c87f2020-11-25T01:31:33ZengElsevierThe Lancet Global Health2214-109X2019-12-01712e1664e1674Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling studyFrédéric Debellut, MSc0Andrew Clark, PhD1Clint Pecenka, PhD2Jacqueline Tate, PhD3Ranju Baral, PhD4Colin Sanderson, ProfPhD5Umesh Parashar, MD6Laura Kallen, MPH7Deborah Atherly, PhD8PATH, Geneva, Switzerland; Correspondence to: Mr Frédéric Debellut, PATH, 1202 Geneva, SwitzerlandLondon School of Hygiene & Tropical Medicine, London, UKPATH, Seattle, WA, USACenters for Disease Control and Prevention, Atlanta, GA, USAPATH, Seattle, WA, USALondon School of Hygiene & Tropical Medicine, London, UKCenters for Disease Control and Prevention, Atlanta, GA, USAPATH, Seattle, WA, USAPATH, Seattle, WA, USASummary: Background: Previous studies have found rotavirus vaccination to be highly cost-effective in low-income countries. However, updated evidence is now available for several inputs (ie, rotavirus disease mortality rates, rotavirus age distributions, vaccine timeliness, and vaccine efficacy by duration of follow-up), new rotavirus vaccines have entered the market, vaccine prices have decreased, and cost-effectiveness thresholds have been re-examined. We aimed to provide updated cost-effectiveness estimates to inform national decisions about the new introduction and current use of rotavirus vaccines in Gavi countries. Methods: We calculated the potential costs and effects of rotavirus vaccination for ten successive birth cohorts in 73 countries previously and currently eligible for Gavi support, compared with no vaccination. We used a deterministic cohort model to calculate numbers of rotavirus gastroenteritis cases, outpatient visits, hospitalisations, and deaths between birth and 5 years, with and without rotavirus vaccination. We calculated treatment costs from the government and societal perspectives. The primary outcome measure was the incremental cost-effectiveness ratio (discounted US$ per disability-adjusted life-year averted). Country-specific model input parameters were based on the scientific literature, published meta-analyses, and international databases. We ran deterministic and probabilistic uncertainty analyses. Findings: Over the period 2018–27, rotavirus vaccination has the potential to prevent nearly 600 000 deaths in Gavi countries. Averted outpatient visits and hospitalisations could lead to treatment savings of approximately $484·1 million from the government perspective and $878·0 million from the societal perspective. The discounted dollars per disability-adjusted life-year averted has a very high probability (>90%) of being less than 0·5 times the gross domestic product per capita in 54 countries, and less than 1·0 times gross domestic product per capita in 63 countries. Interpretation: Rotavirus vaccination continues to represent good value for money across most Gavi countries despite lower rotavirus mortality estimates and more stringent willingness-to-pay thresholds. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X19304395
collection DOAJ
language English
format Article
sources DOAJ
author Frédéric Debellut, MSc
Andrew Clark, PhD
Clint Pecenka, PhD
Jacqueline Tate, PhD
Ranju Baral, PhD
Colin Sanderson, ProfPhD
Umesh Parashar, MD
Laura Kallen, MPH
Deborah Atherly, PhD
spellingShingle Frédéric Debellut, MSc
Andrew Clark, PhD
Clint Pecenka, PhD
Jacqueline Tate, PhD
Ranju Baral, PhD
Colin Sanderson, ProfPhD
Umesh Parashar, MD
Laura Kallen, MPH
Deborah Atherly, PhD
Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
The Lancet Global Health
author_facet Frédéric Debellut, MSc
Andrew Clark, PhD
Clint Pecenka, PhD
Jacqueline Tate, PhD
Ranju Baral, PhD
Colin Sanderson, ProfPhD
Umesh Parashar, MD
Laura Kallen, MPH
Deborah Atherly, PhD
author_sort Frédéric Debellut, MSc
title Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
title_short Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
title_full Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
title_fullStr Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
title_full_unstemmed Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study
title_sort re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 gavi countries: a modelling study
publisher Elsevier
series The Lancet Global Health
issn 2214-109X
publishDate 2019-12-01
description Summary: Background: Previous studies have found rotavirus vaccination to be highly cost-effective in low-income countries. However, updated evidence is now available for several inputs (ie, rotavirus disease mortality rates, rotavirus age distributions, vaccine timeliness, and vaccine efficacy by duration of follow-up), new rotavirus vaccines have entered the market, vaccine prices have decreased, and cost-effectiveness thresholds have been re-examined. We aimed to provide updated cost-effectiveness estimates to inform national decisions about the new introduction and current use of rotavirus vaccines in Gavi countries. Methods: We calculated the potential costs and effects of rotavirus vaccination for ten successive birth cohorts in 73 countries previously and currently eligible for Gavi support, compared with no vaccination. We used a deterministic cohort model to calculate numbers of rotavirus gastroenteritis cases, outpatient visits, hospitalisations, and deaths between birth and 5 years, with and without rotavirus vaccination. We calculated treatment costs from the government and societal perspectives. The primary outcome measure was the incremental cost-effectiveness ratio (discounted US$ per disability-adjusted life-year averted). Country-specific model input parameters were based on the scientific literature, published meta-analyses, and international databases. We ran deterministic and probabilistic uncertainty analyses. Findings: Over the period 2018–27, rotavirus vaccination has the potential to prevent nearly 600 000 deaths in Gavi countries. Averted outpatient visits and hospitalisations could lead to treatment savings of approximately $484·1 million from the government perspective and $878·0 million from the societal perspective. The discounted dollars per disability-adjusted life-year averted has a very high probability (>90%) of being less than 0·5 times the gross domestic product per capita in 54 countries, and less than 1·0 times gross domestic product per capita in 63 countries. Interpretation: Rotavirus vaccination continues to represent good value for money across most Gavi countries despite lower rotavirus mortality estimates and more stringent willingness-to-pay thresholds. Funding: Bill & Melinda Gates Foundation.
url http://www.sciencedirect.com/science/article/pii/S2214109X19304395
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