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Published on: January 28, 2019
Cost-effectiveness of childhood rotavirus vaccination in Taiwan
Chia-Ling Wu1, Yi-Ching Yang, Li-Min Huang
1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Routine infant immunization with rotavirus vaccines (RotaTeq and Rotarix) is unlikely to be cost-saving in Taiwan currently. However, vaccination significantly reduces rotavirus diarrhea cases and serious illness, lowering the disease burden.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Rotavirus is a leading cause of severe diarrhea in children globally.
- Two rotavirus vaccines, RotaTeq and Rotarix, are available for infant immunization.
Purpose of the Study:
- To evaluate the cost-effectiveness of routine infant immunization with RotaTeq and Rotarix in Taiwan.
- To determine the economic impact of rotavirus disease and vaccination from healthcare system and societal perspectives.
Main Methods:
- A decision tree model was employed to estimate disease burden and associated costs.
- Disease outcomes included hospitalizations, emergency department visits, outpatient visits, physician visits, and mortality.
- Cost-effectiveness analysis was conducted from both healthcare system and societal viewpoints.
Main Results:
- Routine rotavirus vaccination could prevent over 146,000 annual cases of rotavirus diarrhea and over 21,000 serious cases (hospitalizations, ED visits, deaths).
- The cost-effectiveness varied by vaccine price, with break-even prices of US$41 (Rotarix) and US$29 (RotaTeq) per dose from a societal perspective.
- Increased hospitalization costs and decreased vaccine prices could enhance cost-effectiveness.
Conclusions:
- Routine rotavirus vaccination is unlikely to be cost-saving in Taiwan at current vaccine prices.
- Vaccination substantially reduces the burden of rotavirus-related morbidity and mortality.
- Lowering vaccine prices is crucial for achieving cost-effectiveness from a societal standpoint.
Objective:
Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vaccines (RotaTeq and Rotarix) have been licensed in Taiwan. We have investigated whether routine infant immunization with either vaccine could be cost-effective in Taiwan.
Methods:
We modeled specific disease outcomes including hospitalization, emergency department visits, hospital outpatient visits, physician office visits, and death. Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree was used to estimate the disease burden and costs based on data from published and unpublished sources.
Results:
A routine rotavirus immunization program would prevent 146,470 (Rotarix) or 149,937 (RotaTeq) cases of rotavirus diarrhea per year, and would prevent 21,106 (Rotarix) and 23,057 (RotaTeq) serious cases (hospitalizations, emergency department visits, and death). At US$80 per dose for the Rotarix vaccine, the program would cost US$32.7 million, provided an increasing cost offset of US$19.8 million to the health care system with $135 per case averted. Threshold analysis identified a break-even price per dose of US$27 from the health care system perspective and US$41 from a societal perspective. At US$60.0 per dose of RotaTeq vaccine, the program would cost US$35.4 million and provide an increasing cost offset of US$22.5 million to the health care system, or US$150 per case averted. Threshold analysis identified a break-even price per dose of US$20.0 from the health care system perspective and $29 from the societal perspective. Greater costs of hospitalization and lower vaccine price could increase cost-effectiveness.
Conclusions:
Despite a higher burden of serious rotavirus disease than estimated previously, routine rotavirus vaccination would unlikely be cost-saving in Taiwan at present unless the price fell to US$41 (Rotarix) or US$29 (RotaTeq) per dose from societal perspective, respectively. Nonetheless, rotavirus immunization could reduce the substantial burden of short-term morbidity due to rotavirus.
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