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Published on: January 28, 2019
Cost-effectiveness of rotavirus vaccination in the Philippines: A modeling study
Maria Esterlita T Villanueva-Uy1, Hilton Y Lam2, Josephine G Aldaba1
1Institute of Child Health and Human Development, University of the Philippines Manila-National Institutes of Health, Manila, Philippines.
Insights
Rotavirus vaccination in the Philippines is cost-effective, averting 40% of disease cases. Rotavac and Rotasiil are the most affordable options, with Rotavac showing strong cost-effectiveness for preventing rotavirus gastroenteritis (RVGE).
Area of Science:
- Public Health
- Health Economics
- Vaccinology
Background:
- Rotavirus gastroenteritis (RVGE) is a major cause of childhood mortality and hospitalization in the Philippines.
- Rotavirus (RV) vaccination's national program introduction in 2012 has been regionally limited due to cost-effectiveness uncertainties.
- Updated cost-effectiveness data is crucial for prioritizing RV vaccination in national immunization strategies.
Purpose of the Study:
- To estimate the cost-effectiveness of four rotavirus vaccines (Rotavac, Rotasiil, Rotarix, Rotateq) over a 10-year period (2021-2031) in the Philippines.
- To compare vaccination costs and benefits from both government and societal perspectives.
- To inform national immunization program decisions regarding rotavirus vaccine introduction.
Main Methods:
- A proportionate outcomes model was used to calculate disease events, DALYs, and costs with and without vaccination.
- Cost-effectiveness was measured as cost per Disability Adjusted Life Year (DALY) averted.
- Analyses compared four vaccine products and assessed cost-effectiveness against national GDP per capita willingness-to-pay thresholds, including sensitivity analyses.
Main Results:
- Any of the four RV vaccines could avert approximately 40% of RVGE cases (visits, hospitalizations, deaths) between 2021-2031.
- Rotavac and Rotasiil were the most cost-effective vaccines from both government and societal perspectives.
- Rotavac's cost-effectiveness was $1,148/DALY averted (government) and $646/DALY averted (societal); it demonstrated >99% probability of cost-effectiveness at 0.5x GDP per capita.
Conclusions:
- Rotavac and Rotasiil present likely cost-effective options for RV vaccination in the Philippines.
- Rotarix and Rotateq offer similar benefits but at a higher cost, requiring significant price reductions for consideration.
- The study supports the cost-effectiveness of rotavirus vaccination, particularly for Rotavac and Rotasiil, to reduce RVGE burden.
Introduction:
Rotavirus gastroenteritis (RVGE) remains a leading cause of hospitalization and death in children under five years of age in the Philippines. Rotavirus (RV) vaccination was introduced into the national immunization program (NIP) in 2012 but has since been limited to one region due to cost considerations and conflicting local cost-effectiveness estimates. Updated estimates of the cost-effectiveness of RV vaccination are required to inform prioritization of national immunization activities.
Methods:
We calculated the potential costs and benefits of rotavirus vaccination over a 10-year-period (2021-2031) from a government and societal perspective, comparing four alternative rotavirus vaccines: Rotavac, Rotasiil, Rotarix and Rotateq. For each vaccine, a proportionate outcomes model was used to calculate the expected number of disease events, DALYs, vaccination program costs, and healthcare costs, with and without vaccination. The primary outcome measure was the cost per DALY averted. Assuming each product would generate similar benefits, the dominant (lowest cost) product was identified. We then calculated the cost-effectiveness (US$ per Disability Adjusted Life Year [DALY] averted) of the least costly product and compared it to willingness-to-pay thresholds of 0.5 and 1 times the national GDP per capita ($3,485), and ran deterministic and probabilistic sensitivity analyses.
Results:
Introducing any of the four rotavirus vaccines would avert around 40% of RVGE visits, hospitalizations, and deaths over the period 2021-2031. Over the same ten-year period, the incremental cost of vaccination from a government perspective was estimated to be around $104, $105, $220, and $277 million for Rotavac, Rotasiil, Rotarix and Rotateq, respectively. The equivalent cost from a societal perspective was $58, $60, $178 and $231 million. The cost-effectiveness of the least costly product (Rotavac) was $1,148 ($830-$1682) from a government perspective and $646 ($233-1277) from a societal perspective. All other products offered similar benefits but at a higher cost. There is a >99% probability that Rotavac would be cost-effective at a willingness-to-pay threshold set at 0.5 times the national GDP per capita.
Conclusion:
Both Rotavac and Rotasiil are likely to be cost-effective options in the Philippines, but it is not possible to say definitively which product should be preferred. Rotarix and Rotateq are expected to offer similar benefits at more cost, so would need to be priced far more competitively to be considered for introduction.
