Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Nigeria

PLoS One. 2020 May 29;15(5):e0232941. doi: 10.1371/journal.pone.0232941. eCollection 2020.

Abstract

Child mortality from rotavirus gastroenteritis remains high in Nigeria, representing 14% of all rotavirus deaths worldwide. Here, we examine the potential impact and cost-effectiveness of national rotavirus vaccine introduction in geographic and economic subpopulations of Nigeria. We projected the health and economic outcomes of rotavirus vaccination in children over the first five years of life using a spreadsheet-based model. We modeled child populations using national survey data on rotavirus mortality risk factors and vaccination coverage to predict burden and impact across regional and wealth quintile subpopulations within Nigeria. Our base case considered introduction of a general rotavirus vaccine, modeled to encompass characteristics of existing vaccines, versus no vaccine. Base case costs were estimated from the government perspective, assuming Gavi subsidies, over the first five years. We also present estimates from the cost of vaccination from the perspective of Gavi. We explored uncertainty in model parameters through probabilistic uncertainty, one-way sensitivity, and scenario analyses. According to our estimates, rotavirus enteritis was responsible for 47,898 [95% Uncertainty Limits: 35,361; 63,703] child deaths per year, with approximately 80% of the national burden concentrated in the three northern regions of Nigeria. Rotavirus vaccination was estimated to prevent 6,454 [3,960; 9,721] deaths, 13% [9%; 18%] of the national annual RV burden. National ICERs for rotavirus vaccination from the Nigerian government and Gavi perspectives were US$47 [$18; $105] and $62 [$29; $130] per DALY averted, respectively. General rotavirus vaccination was projected to reduce rotavirus mortality by only 6% [4%; 9%] in the North West region compared to 35% [24%; 47%] in the South East region. Base case ICERs ranged from US$25 [10; 56] per DALY averted in North West to US$64 [18; 157] per DALY averted in South South. Gavi perspective ICERs ranged from US$33 [$15; $68] in North West to US$88 [35; 191] per DALY averted in South South. According to one-way sensitivity analyses, ICERs were most sensitive to vaccine efficacy, followed by estimated administrative costs and rotavirus mortality. Disparities in mortality reduction were largely driven by inequality in vaccination coverage across regions and between socioeconomic subpopulations. Due to high, persistent, and inequitable burden of rotavirus in Nigeria, routine vaccination with any of these rotavirus vaccines would be an high impact and cost-effective strategy in reducing child mortality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Cost of Illness
  • Cost-Benefit Analysis
  • Diarrhea / virology
  • Female
  • Health Policy
  • Humans
  • Immunization Programs / economics
  • Infant
  • Male
  • Models, Theoretical
  • Nigeria / epidemiology
  • Risk Factors
  • Rotavirus / immunology
  • Rotavirus / pathogenicity
  • Rotavirus Infections / economics
  • Rotavirus Infections / mortality
  • Rotavirus Infections / prevention & control*
  • Rotavirus Vaccines / economics*
  • Rotavirus Vaccines / immunology
  • Vaccination / economics
  • Vaccination Coverage

Substances

  • Rotavirus Vaccines

Grants and funding

CP received funding from the Bill and Melinda Gates Foundation: Grant #OPP1147721 entitled “Generating evidence to support rotavirus vaccine optimization." https://www.gatesfoundation.org The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Bagamian Scientific Consulting provided support in the form of salaries for authors KHB but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.”