Related Experiment Video
Updated: May 11, 2026
Assays for the Specific Growth Rate and Cell-binding Ability of Rotavirus
Published on: January 28, 2019
Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal
Patricia Bruijning-Verhagen1, Marie-Josée J Mangen, Mariet Felderhof
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR,6,131, Postbus 85500, Utrecht 3508 GA, The Netherlands. P.Bruijning@umcutrecht.nl
Insights
Targeted rotavirus (RV) vaccination for high-risk infants is highly cost-effective, potentially saving costs. Universal RV vaccination is less cost-effective unless specific conditions are met, making targeted vaccination the recommended approach.
Area of Science:
- Pediatrics
- Public Health
- Health Economics
Background:
- Rotavirus (RV) vaccination cost-effectiveness is debated in developed nations, leading to limited existing programs.
- Hospitalization is the primary cost driver for RV disease.
- Prematurity, low birth weight (LBW), and congenital conditions increase risks for RV hospitalization and complications.
Purpose of the Study:
- To investigate the cost-effectiveness of targeted RV vaccination for high-risk infants.
- To compare universal RV vaccination strategies against no vaccination.
- To analyze RV disease burden, mortality, and healthcare costs in vulnerable infant populations.
Main Methods:
- Utilized two hospital-based observational studies in the Netherlands to quantify RV disease burden, mortality, and costs.
- Employed an age-structured stochastic multi-cohort model for cost-effectiveness analysis.
- Calculated incremental cost-effectiveness ratios (ICERs) with a €35,000/QALY threshold from a healthcare provider perspective.
Main Results:
- High-risk infants (prematurity, LBW, congenital pathology) faced significantly higher risks of RV hospitalization, ICU admission, prolonged stays, and costs.
- Targeted RV vaccination demonstrated high cost-effectiveness (ICERs < €20,000/QALY) and potential cost savings.
- Universal RV vaccination was not cost-effective unless herd immunity and caretaker QALY losses were considered, and vaccine prices were low (€60).
Conclusions:
- Targeted rotavirus (RV) vaccination for high-risk infants is a recommended strategy in developed countries.
- This approach offers significant health and economic benefits compared to no vaccination.
- Further consideration of universal vaccination requires specific economic and epidemiological conditions.
Background:
The cost-effectiveness of universal rotavirus (RV) vaccination is controversial in developed countries. As a result, RV vaccination programs do not currently exist in most European countries. Hospitalization is the main driver of RV disease costs, and prematurity, low birth weight (LBW) and underlying medical conditions have been associated with RV hospitalization and complications. We investigated the cost-effectiveness of targeted RV vaccination of high-risk infants and universal RV vaccination versus no vaccination.
Methods:
Disease burden, mortality and healthcare costs of RV hospitalization for children with and without prematurity, LBW and congenital pathology were quantified in two hospital-based observational studies in the Netherlands. Cost-effectiveness analysis was based on an age-structured stochastic multi-cohort model of the Dutch population comparing universal RV vaccination and targeted vaccination of high-risk infants to no vaccination. The primary endpoint was the incremental cost-effectiveness ratio (ICER), with a threshold of €35,000/quality-adjusted life year (QALY) from the healthcare provider perspective. Sensitivity analyses included vaccine price and coverage, herd-immunity and QALY losses.
Results:
A total of 936 children with RV infection were included. Prematurity, LBW and congenital pathology were associated with increased risks of RV hospitalization (relative risks (RR) ranging from 1.6 to 4.4), ICU admission (RR ranging from 4.2 to 7.9), prolonged hospital stay (1.5 to 3.0 excess days) and higher healthcare costs (€648 to €1,533 excess costs). Seven children succumbed due to RV complications, all belonging to the high-risk population. Targeted RV vaccination was highly cost-effective and potentially cost-saving from the healthcare provider perspective with ICERs below €20,000/QALY in all scenarios with total (undiscounted) annual healthcare costs between -€0.1 and €0.5 million/year. Results were most sensitive to mortality rates, but targeted vaccination remained highly cost-effective up to reductions of 90% compared to observed mortality. Universal RV vaccination was not considered cost-effective (mean ICER: €60,200/QALY) unless herd-immunity and caretaker QALY losses were included and vaccine prices were €60 at most (mean ICER: €21,309/QALY).
Conclusion:
We recommend targeted RV vaccination for high-risk infants in developed countries.
