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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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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