Economic evaluation of rotavirus vaccination in children of Bhutan

Pempa; Alia Cynthia G Luz; Nantasit Luangasanatip; Pritaporn Kingkaew; Deepika Adhikari; Wanrudee Isaranuwatchai; Dechen Choiphel; Clint Pecenka; Frédéric Debellut

doi:10.1016/j.vaccine.2020.05.035

Economic evaluation of rotavirus vaccination in children of Bhutan

Vaccine. 2020 Jul 6;38(32):5049-5059. doi: 10.1016/j.vaccine.2020.05.035. Epub 2020 Jun 7.

Authors

Pempa¹, Alia Cynthia G Luz², Nantasit Luangasanatip³, Pritaporn Kingkaew⁴, Deepika Adhikari¹, Wanrudee Isaranuwatchai⁵, Dechen Choiphel¹, Clint Pecenka⁶, Frédéric Debellut⁷

Affiliations

¹ Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan.
² Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand.
³ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Thailand.
⁴ Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand. Electronic address: pritaporn.k@hitap.net.
⁵ Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
⁶ PATH, USA.
⁷ PATH, Switzerland.

Abstract

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.

Keywords: Bhutan; Budget impact analysis; Cost-effectiveness analysis; DALYs; Human resource impact analysis; Rotavirus; Vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bhutan / epidemiology
Child
Cost-Benefit Analysis
Humans
Immunization Programs
Infant
Rotavirus Infections* / epidemiology
Rotavirus Infections* / prevention & control
Rotavirus Vaccines*
Rotavirus*
Vaccination

Substances

Rotavirus Vaccines