Projected Impact and Cost-Effectiveness of a Rotavirus Vaccination Program in India, 2008

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Clinical Infectious Diseases
http://www.journals.uchicago.edu/toc/cid/current

Projected Impact and Cost-Effectiveness of a Rotavirus Vaccination Program in India, 2008
Douglas H. Esposito, Jacqueline E. Tate, Gagandeep Kang and Umesh D. Parashar

Abstract
Background. To assess the value of rotavirus vaccination in India, we determined the potential impact and cost-effectiveness of a national rotavirus vaccination program.

Methods.  We compared the national rotavirus disease and cost burden with and without a vaccination program and assessed the cost-effectiveness of vaccination. Model inputs included measures of disease and cost burden, vaccine performance, and vaccination coverage and cost. We measured the annual number of health-related events and treatment costs averted, as well as the cost-effectiveness in US dollars per disability-adjusted life-year (DALY) and cost per death averted. One-way sensitivity analyses were performed by individually varying each model input.

Results. With use of a vaccine that has an estimated effectiveness of 50%, a rotavirus vaccination program in India would prevent approx 44,000 deaths, 293,000 hospitalizations, and 328,000 outpatient visits annually, which would avert $20.6 million in medical treatment costs. Vaccination would be cost-saving at the GAVI Alliance price of $0.15 per dose. At $1.00 per dose, a vaccination program would cost $49.8 million, which would result in an expenditure of $21.41 per DALY averted or $662.94 per life saved. Even at $7.00 per dose, vaccination would be highly cost-effective. In sensitivity analyses, varying efficacy against severe rotavirus disease and vaccine price had the greatest impact on cost-effectiveness.

Conclusions. A national rotavirus vaccination program in India would prevent substantial rotavirus morbidity and mortality and would be highly cost-effective at a range of vaccine prices. Public health officials can use this locally derived data to evaluate how this highly cost-effective intervention might fit into India’s long-term health care goals.