BMC Public Health
(Accessed 7 December 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia
Auliya A Suwantika and Maarten J Postma
BMC Public Health 2013, 13:1106  doi:10.1186/1471-2458-13-1106
Published: 1 December 2013
http://www.biomedcentral.com/1471-2458/13/1106/abstract

Abstract (provisional)
Background

Rotavirus infection has been reported to be responsible for the majority of severe diarrhea in children under-5-years-old in Indonesia. Breast milk is considered to protect against rotavirus infection and increasing breastfeeding promotion programs could be an alternative target to reduce the incidence of rotavirus diarrhea. This study aims to investigate the effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia, focusing on breastfeeding education and support interventions.

Methods

An age-structured cohort model was developed for the 2011 Indonesia birth cohort. We compared four interventions in scenarios: (i) base-case (I0) reflecting the current situation for the population of under-5-years-old, (ii) with an additional breastfeeding education intervention (I1), (iii) with a support intervention on initiation and duration (I2) and (iv) with both of these two interventions combined (I3). The model applied a 5-year-time-horizon, with 1 month analytical cycles for children less than 1 year of age and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of rotavirus vaccination.

Results

Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of a child’s life even assuming various breastfeeding promotion interventions. The total yearly vaccine cost would amount to US$ 64 million under the market vaccine price. Cost-effectiveness would increase to US$ 153 (societal perspective) with an optimal breastfeeding promotion intervention. Obviously, this is much lower than the 2011 Gross Domestic Product (GDP) per capita of US$ 3,495. Affordability results showed that at the market vaccine price, rotavirus vaccination could be affordable for the Indonesian health system.

Conclusions

Rotavirus immunization would be a highly cost-effective public health intervention for Indonesia even under various breastfeeding promotion interventions based on the WHO’s criteria for cost-effectiveness in universal immunization.