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Published on: January 28, 2019
Impact and cost-effectiveness of rotavirus vaccination in Bangladesh
Clint Pecenka1, Umesh Parashar2, Jacqueline E Tate2
1PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA.
Insights
Introducing rotavirus vaccination in Bangladesh is highly cost-effective, preventing thousands of deaths and hospitalizations annually. The program offers significant public health benefits, even without subsidies, demonstrating its value for child survival.
Area of Science:
- Global Health
- Vaccinology
- Health Economics
Background:
- Diarrheal disease is a major global child mortality cause, with rotavirus responsible for over a third of deaths.
- In 2013, rotavirus caused an estimated 215,000 deaths in children under five, disproportionately affecting Asia.
- Bangladesh, despite high rotavirus burden, had not yet introduced rotavirus vaccination but planned for 2018.
Purpose of the Study:
- To evaluate the impact and cost-effectiveness of introducing rotavirus vaccination in Bangladesh.
- To estimate the costs associated with a rotavirus vaccination program.
- To provide data for decision-makers regarding rotavirus vaccine introduction.
Main Methods:
- Utilized the Pan American Health Organization's TRIVAC model (version 2.0) for analysis.
- Compared nationwide introduction of a two-dose rotavirus vaccine in 2017 versus no vaccination.
- Assessed three mortality scenarios (low, high, midpoint) from a societal perspective over ten birth cohorts with a 3% discount rate.
Main Results:
- Rotavirus vaccination is projected to prevent 4,000 deaths, 500,000 hospitalizations, and 3 million outpatient visits over ten years in the base scenario.
- Cost per disability-adjusted life year (DALY) averted ranged from $58-$142 with Gavi subsidy.
- Without subsidy, cost per DALY averted ranged from $615-$1514, with a vaccine price of $2.19 per dose.
Conclusions:
- Rotavirus vaccination is highly cost-effective in Bangladesh, with discounted cost per DALY averted below GDP per capita in most scenarios.
- The vaccination program demonstrates cost-effectiveness even in low-mortality settings without subsidies.
- Estimated cost-effectiveness is conservative, excluding potential herd immunity benefits.
Introduction:
Diarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners.
Methods:
This analysis used Pan American Health Organization's TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates.
Results:
Over ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted.
Conclusion:
The discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination in Bangladesh.
