OBJECTIVES: Several studies have shown rotavirus vaccine is cost effective in low and middle income countries. Despite this, competing choices of rotavirus vaccines make the selection of either vaccine difficult for health decision-makers in low resource settings. The objective of this study is to assess cost effectiveness of the monovalent (MNV) and pentavalent (PTV) rotavirus vaccines on children mortality in 116 low and middle income countries that represent ∼99% of rotavirus mortality. METHODS: A decision economic model was built to estimate the effect of MNV or PTV vaccination. Inputs were gathered from international databases, previous research and a systematic review of MNV and PTV vaccine effectiveness. Outcomes were reported in terms of cost per disability-adjusted life-year (DALY) averted, comparing no vaccination being implemented on selected countries for the year 2010 with either MNV or PTV introduction. Costs were expressed in 2010 international dollars. RESULTS: Low and middle income countries would have had 601,511 deaths in 2010, if rotavirus vaccine would not have been used. Under no vaccine scenario, 139 DALYs per 1000 children, 1.57 million inpatient and 9.17 million outpatient cases would occur every year. MNV would avert 53.3% of rotavirus-related deaths, and PTV 57.9%. MNV and PTV were highly cost effective worldwide, according to WHO criteria (less than per capita gross domestic product). I$143 cost per DALY for MNV versus I$152 cost per DALY for PTV. Uncertainty was lower in low income countries. CONCLUSIONS: Rotavirus vaccine is cost-effective in all analyzed countries. Despite cost effectiveness analysis is a useful tool for decision making in middle income countries, for low income countries health-decision makers should also assess the impact of introducing either vaccine on local resources, and budget impact analysis of vaccination.
Paternina-Caicedo, A., De la Hoz-Restrepo, F., Carrasquilla-Sotomayor, M., Alvis-Zakzuk, N., & Alvis-Guzmán, N. (2013). Potential Epidemiological And Economic Impact Of Different Rotavirus Vaccines In Low And Middle Income Countries. Value in Health, 16(3), A91. https://doi.org/10.1016/j.jval.2013.03.424