An impact and cost-effectiveness analysis of rotavirus vaccine introduction in Egypt

Rotavirus vaccines have been introduced in several countries, though not in Egypt where domestic vaccine production is a strategic goal. Evidence on the potential costs and consequences of rotavirus vaccination could inform Egypt's vaccine priority-setting.

We evaluated the potential impact and cost-effectiveness of introducing three alternative products (ROTARIX®, ROTASIIL®, or ROTAVAC®) compared to no vaccination over a ten-year period. The primary outcome measure was incremental cost per disability-adjusted life year averted from a government perspective. We used a static cohort model with a finely disaggregated age structure (weeks of age < 5 years) to calculate the program costs and the number of rotavirus gastroenteritis cases, clinic visits, hospital admissions, deaths, and healthcare costs with and without vaccination. We ran probabilistic and deterministic uncertainty analyses.

We estimate that a decade of rotavirus vaccination in Egypt could prevent >11 million RVGE cases, >7 million clinic visits, >700,000 hospital admissions, and > 1400 deaths in children <5 years old. ROTASIIL would have the lowest program cost (US$306 million), followed by ROTAVAC (US$313 million) and ROTARIX (US$400 million). We also estimate that ˃64 % of RVGE healthcare costs could be prevented with rotavirus vaccination. In the base case analysis, ROTASIIL dominated the other two products because it generated the same or better health benefits at lower cost, but it had an 18 % probability of being cost effective at 1 times GDP per capita threshold from the government perspective. The results were highly sensitive to the per-dose price and assumptions about the health system delivery cost per dose.

Rotavirus vaccination could prevent a substantial number of RVGE cases, visits, hospitalizations and deaths in children. To be considered a cost-effective use of government health spending, the vaccine price would need to be reduced and/or lower health system delivery cost assumptions would need to be justified.