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Assays for the Specific Growth Rate and Cell-binding Ability of Rotavirus
Published on: January 28, 2019
Cost effectiveness analysis of rotavirus vaccination in Indonesia
Jarir At Thobari1, Emma Watts2, Natalie Carvalho3
1Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Center for Child Health, Pediatric Research Office (CCH/PRO), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Insights
Introducing rotavirus vaccines (RVV) into Indonesia's National Immunization Program is highly cost-effective. This strategy can prevent millions of rotavirus cases and disability-adjusted life years (DALYs) in children under five.
Area of Science:
- Public Health
- Vaccinology
- Health Economics
Background:
- Rotavirus (RV) is a primary cause of severe acute gastroenteritis (AGE) in children globally, particularly in Indonesia.
- In Indonesia, RV accounts for a significant proportion of severe (60%) and non-severe (40%) AGE cases in children under five.
- This study evaluates the economic viability of integrating rotavirus vaccines (RVV) into the national immunization schedule.
Purpose of the Study:
- To assess the cost-effectiveness of introducing rotavirus vaccines (RVV) into Indonesia's National Immunization Program.
- To compare the economic impact from both healthcare system and societal perspectives.
- To determine the incremental cost per disability-adjusted life year (DALY) averted by RVV introduction.
Main Methods:
- A cost-effectiveness analysis (CEA) was performed using a three-dose RVV schedule.
- The analysis considered an initial phase with an imported RVV, followed by a staged introduction of a locally produced RVV.
- Model inputs were derived from Indonesian cost-of-illness studies, national data, and scientific literature, with sensitivity analyses conducted.
Main Results:
- A 10-year vaccination program is estimated to cost $82.6 million USD.
- The program has the potential to prevent 7.3 million rotavirus cases and 0.42 million DALYs.
- The incremental cost-effectiveness ratio (ICER) was $464 USD per DALY averted from a societal perspective (12% of GDP per capita) and $479 USD from a healthcare perspective (13% of GDP per capita).
Conclusions:
- The introduction of rotavirus vaccines into Indonesia's National Immunization Program is projected to be highly cost-effective.
- RVV implementation offers significant public health benefits by reducing disease burden and improving child survival.
- The findings support the strategic inclusion of RVV in national immunization policies for Indonesia.
Background:
Rotavirus (RV) remains the most common cause of morbidity and mortality due to acute gastroenteritis (AGE) in children under five. In Indonesia, RV is responsible for 60 % of severe AGE and 40 % of non-severe AGE in these children. This study assessed the cost-effectiveness of introduction of rotavirus vaccines (RVV) into the National Immunization Program in Indonesia.
Methods:
We conducted a cost-effectiveness analysis (CEA) of RVV introduction in Indonesia, assuming a three-dose vaccine schedule based on the planned introduction proposed by the Strategic Advisory Group of Experts on Immunization. The analysis involved an initial introduction of an imported RVV (Rotavac®, Bharat Biotech, India) followed by a staged implementation of the locally produced RVV (Bio Farma, Indonesia) from both health system and societal perspectives. The primary outcome measure was the incremental cost (2019 USD) per disability-adjusted life year (DALY) averted, compared to no vaccination. We took model inputs from an Indonesian cost-of-illness study, national information systems and scientific literature, covering disease incidence, hospitalization, mortality, healthcare costs, and vaccine related factors. Our analyses included univariate and probabilitistic sensitivity analyses to assess various parameters.
Findings:
The cost of a 10-year vaccination program is 82.6 million USD and can potentially prevent 7.3 million cases of rotavirus and 0.42 million DALYs. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the staged program is 464 USD per DALY averted (12 % of Indonesia's gross domestic product (GDP) per capita). From a healthcare sector perspective, ICER is similar at 479 USD (13 % GDP per capita).
Interpretation:
The introduction of RVV into the National Immunization Program is likely to be highly cost-effective in Indonesia.
Funding:
This work was supported by funding agreement with the Murdoch Children's Research Institute (MCRI), PATH, and the Indonesian Technical Advisory Group on Immunization (ITAGI).
