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Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran
Mehdi Javanbakht1, Maziar Moradi-Lakeh2, Mohsen Yaghoubi3
1Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Insights
Introducing rotavirus vaccine (RV5) in Iran is a highly cost-effective strategy, preventing significant childhood disability and mortality from diarrhea. This vaccination program offers substantial savings for both the health system and society.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Diarrheal diseases remain a significant burden for children under five in Iran, despite declining mortality rates.
- Rotavirus vaccines are recognized as effective interventions against diarrheal diseases in specific epidemiological contexts.
Purpose of the Study:
- To assess the cost-effectiveness of introducing the pentavalent rotavirus vaccine (RotaTeq, RV5) into Iran's national immunization program.
- To evaluate the economic impact from both the health system and societal perspectives.
Main Methods:
- Utilized the TRIVAC decision support model to calculate incremental costs and health gains (Life Years gained, Disability-Adjusted Life Years averted).
- Compiled data from valid sources, systematic reviews, and meta-analyses; employed WHO guidelines for vaccination cost estimation.
- Applied a 3% annual discount rate for costs and health gains, and conducted deterministic sensitivity analysis to ensure result robustness.
Main Results:
- The rotavirus vaccine could prevent 76,591 Disability-Adjusted Life Years (DALYs) out of a potential 138,161 lost over 10 years.
- The total vaccination cost was estimated at US$499.91 million over 10 cohorts, with projected savings of US$470.61 million from reduced healthcare utilization (societal perspective).
- The cost per DALY averted was US$2868, indicating a highly cost-effective strategy from the government viewpoint; sensitivity analysis supported cost-effectiveness across most scenarios.
Conclusions:
- The introduction of the rotavirus vaccine (RV5) presents a highly cost-effective strategy for the Iranian government.
- Integrating this vaccine into the national immunization program represents an efficient allocation of resources to mitigate child mortality and morbidity.
Background:
Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society.
Methods:
The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results.
Results:
Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario.
Conclusion:
Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
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