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Published on: January 28, 2019
Effectiveness and cost-effectiveness of pediatric rotavirus vaccination in British Columbia: a model-based evaluation
David N Fisman1, Christina H Chan, Elizabeth Lowcock
1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. david.fisman@utoronto.ca
Insights
Childhood rotavirus gastroenteritis (RVGE) vaccination in Canada is highly cost-effective, preventing infections and hospitalizations. While increasing healthcare costs slightly, RVGE vaccines offer significant public health benefits.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Rotavirus gastroenteritis (RVGE) causes significant childhood illness and healthcare use globally.
- Canada has approved two live rotavirus vaccines, RotaTeq and Rotarix, but their economic value is unevaluated.
- Understanding the cost-effectiveness of RVGE vaccination is crucial for Canadian healthcare policy.
Purpose of the Study:
- To evaluate the economic attractiveness of rotavirus vaccines in the Canadian context.
- To model the impact of RVGE vaccination on disease burden and healthcare utilization in British Columbia children.
Main Methods:
- A Markov chain Monte Carlo simulation model was used for economic analysis.
- Models were parameterized with data on RVGE natural history, epidemiology, vaccine effectiveness, and costs.
- Sensitivity analyses were conducted to assess the robustness of projections.
Main Results:
- Childhood immunization is projected to prevent 63-81 RVGE infections per 100 children.
- Vaccination is expected to prevent 1-2 hospitalizations per 100 children immunized.
- Rotarix demonstrated higher cost-effectiveness ($2400 per QALY gained) compared to RotaTeq.
Conclusions:
- RVGE vaccination in British Columbia children significantly reduces disease burden and healthcare utilization.
- Vaccination is projected to result in a modest increase in healthcare costs.
- Rotavirus vaccination is considered highly cost-effective compared to other health interventions.
Background:
Rotavirus gastroenteritis (RVGE) is associated with widespread morbidity and mortality in children worldwide. In high-income countries, including Canada, the burden of RVGE relates largely to morbidity and healthcare utilization. Two live rotavirus vaccines (RotaTeq(®) (Merck Frosst Canada Ltd.) and Rotarix™ (GlaxoSmithKline Inc.)), are now approved for use in Canada, but their economic attractiveness has not been evaluated in the Canadian context.
Methods:
We performed a model-based economic analysis using a Markov chain Monte Carlo simulation of RVGE in populations of British Columbia children. Models were parameterized based on best available data on disease natural history and epidemiology, vaccine effectiveness and cost, and healthcare costs, and calibrated such that projections of healthcare utilization and vaccine coverage closely matched empirical estimates. Robustness of projections was evaluated in deterministic and probabilistic sensitivity analyses.
Results:
Based on the best available data, childhood immunization against RVGE was projected to prevent 63-81 infections per 100 children vaccinated, and to prevent substantial numbers of outpatient medical visits. It was projected that either vaccine would prevent 1-2 hospitalizations per 100 children immunized. Vaccination was projected to increase healthcare costs: immunization with Rotarix™ would prevent incident infections at a cost of approximately $10 per infection prevented or $2400 per quality-adjusted life-year gained. Vaccination with RotaTeq™ would be more costly and less effective and would not be preferred. Projections were robust in the face of wide-ranging sensitivity analyses.
Interpretation:
The use of currently available vaccines against RVGE in British Columbia children is projected to result in a substantial reduction in the burden of illness and healthcare utilization associated with RVGE, with a modest increase in healthcare costs. RVGE vaccination should be considered "highly cost-effective" relative to other commonly available health interventions.
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