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Published on: January 28, 2019
Economic evaluation of rotavirus vaccination in children of Bhutan
Pempa1, Alia Cynthia G Luz2, Nantasit Luangasanatip3
1Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan.
Insights
Introducing rotavirus vaccines in Bhutan is unlikely to be cost-effective at current thresholds. However, ROTASIIL and ROTAVAC vaccines offer the best value for money, potentially falling under higher cost-effectiveness thresholds.
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Diarrhoea is a leading cause of under-five morbidity in Bhutan.
- Rotavirus is a primary driver of child diarrhoeal hospitalizations.
Purpose of the Study:
- To assess the health outcomes, cost-effectiveness, and resource implications of introducing rotavirus vaccines in Bhutan.
- To inform national decision-making regarding rotavirus vaccine implementation.
Main Methods:
- Utilized the UNIVAC model (version 1.3.41) for cost-effectiveness analysis from a governmental perspective.
- Projected impacts on human resources and budget.
- Conducted sensitivity and threshold analyses to address parameter uncertainties.
Main Results:
- A 10-year rotavirus vaccination program could avert 104–115 DALYs at an incremental cost of $322,000–$1,332,000.
- Incremental Cost-Effectiveness Ratios (ICERs) ranged from $2,803 to $11,606 per DALY averted for different vaccines.
- The net five-year budget impact ranged from $0.20 to $0.81 million, with a need for additional health assistants.
Conclusions:
- Routine rotavirus vaccination is unlikely to be cost-effective at Bhutan's current threshold for most vaccines.
- Vaccination with ROTASIIL falls under a higher threshold (1x GDP per capita).
- ROTASIIL and ROTAVAC present the best value for money for Bhutan's rotavirus vaccination program.
Background:
Diarrhoea remains one of the top ten causes of under-five child morbidity in Bhutan, and rotavirus is a significant cause of child diarrhoeal hospitalisations. This study sought to determine the health outcomes, cost-effectiveness, and budget and human resource implications of introducing rotavirus vaccines in the routine immunisation program to inform Bhutan's decision-making process.
Methods:
We used UNIVAC model (version 1.3.41) to evaluate the cost-effectiveness of a rotavirus vaccination programme compared with no vaccination from a government perspective. We also projected the impact of rotavirus vaccination on human resources and budget. Acost-effectiveness threshold was determined to be 0.5 times the gross domestic product (GDP) per capita (equivalent to the United States dollar ($) 1,537) per Disability-Adjusted Life-Year (DALY) averted.One-way deterministic and probabilistic sensitivity analyses, and threshold analyses were performed to capture parameter uncertainties.
Results:
In Bhutan, a rotavirus vaccination programme over 10 years (2020 to 2029) can avert between 104 and 115 DALYs, at an incremental cost ranging from $322,000 to $1,332,000. The incremental cost-effectiveness ratio (ICER) across four vaccination programmes compared to no vaccination scenario were $9,267, $11,606, $3,201, and $2,803 per DALY averted for ROTARIX, RotaTeq, ROTAVAC, and ROTASIIL, respectively. The net five-year budget impact of introducing a rotavirus vaccination programme ranged from $0.20 to $0.81 million. The rotavirus vaccination programme has a potential to reduce the workload of health care workers such as paediatricians, nurses, dieticians, and pharmacists; however, the programme would require an additional 1.93-2.88 full-time equivalent of health assistants.
Conclusion:
At the current cost-effectiveness threshold, routine rotavirus vaccination in Bhutan is unlikely to be cost-effective with any of the currently available vaccines. However, routine vaccination with ROTASIIL was under the cost-effectiveness threshold of one times the GDP per capita ($3,074). ROTASIIL and ROTAVAC would provide the best value for money in Bhutan.
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