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Mohy A, Lagoubi Y, Gomez JA, Amadou B, Bouskraoui M. Health economic evaluation of 2-dose and 3-dose rotavirus vaccines in children below 5 years of age in Morocco. Hum Vaccin Immunother 2024; 20:2353480. [PMID: 38757507 PMCID: PMC11110695 DOI: 10.1080/21645515.2024.2353480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Following the introduction of rotavirus vaccination into the Moroccan National Immunization Program, the prevalence of the disease has decreased by nearly 50%. However, evidence on the economic value of rotavirus vaccinations in Morocco is limited. This health economic analysis evaluated, from both country payer and societal perspectives, the costs and the cost-effectiveness of three rotavirus vaccines using a static, deterministic, population model in children aged < 5 years in Morocco. Included vaccines were HRV (2-dose schedule), HBRV (3-dose schedule) and BRV-PV 1-dose vial (3-dose schedule). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The model predicted that vaccination with HRV was estimated to result in fewer rotavirus gastroenteritis events (-194 homecare events, -57 medical visits, -8 hospitalizations) versus the 3-dose vaccines, translating into 7 discounted quality-adjusted life years gained over the model time horizon. HRV was associated with lower costs versus HBRV from both the country payer (-$1.8 M) and societal (-$4.1 M) perspectives, and versus BRV-PV 1-dose vial from the societal perspective (-$187,000), dominating those options in the cost-effectiveness analysis. However, costs of BRV-PV 1-dose vial were lower than HRV from the payer perspective, resulting in an ICER of approximately $328,376 per QALY, above the assumed cost effectiveness threshold of $3,500. Vaccination with a 2-dose schedule of HRV may be a cost-saving option and could lead to better health outcomes for children in Morocco versus 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- Value Evidence & Outcomes Emerging Markets, GSK, Wavre, Belgium
| | | | - Jorge A. Gomez
- Vaccines, Emerging Markets, GSK, Buenos Aires, Argentina
| | - Barry Amadou
- Vaccines Emerging Markets, GSK, Casablanca, Morocco
| | - Mohammed Bouskraoui
- Faculté de Médecine et de Pharmacie, Cadi Ayyad University, Marrakech, Morocco
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods Used by Pediatric Cost-Utility Analyses to Include Family Spillover Effects. PHARMACOECONOMICS 2024; 42:199-217. [PMID: 37945777 PMCID: PMC10810985 DOI: 10.1007/s40273-023-01331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND A child's health condition affects family members' health and well-being. However, pediatric cost-utility analysis (CUA) commonly ignores these family spillover effects leading to an incomplete understanding of the cost and benefits of a child's health intervention. Methodological challenges exist in assessing, valuing, and incorporating family spillover effects. OBJECTIVE This study systematically reviews and compare methods used to include family spillover effects in pediatric CUAs. METHODS A literature search was conducted in MEDLINE, Embase, EconLit, Cochrane collection, CINAHL, INAHTA, and the Pediatric Economic Database Evaluation (PEDE) database from inception to 2020 to identify pediatric CUAs that included family spillover effects. The search was updated to 2021 using PEDE. The data describing in which family members spillover effects were measured, and how family spillover effects were measured, incorporated, and reported, were extracted. Common approaches were grouped conceptually. Further, this review identified theories or theoretical frameworks used to justify approaches for integrating family spillover effects into CUA. RESULTS Of 878 pediatric CUAs identified, 35 included family spillover effects. Most pediatric CUAs considered family spillover effects on one family member. Pediatric CUAs reported eight different approaches to measure the family spillover effects. The most common method was measuring the quality-adjusted life years (QALY) loss of the caregiver(s) or parent(s) due to a child's illness or disability using an isolated approach whereby family spillover effects were quantified in individual family members separately from other health effects. Studies used four approaches to integrate family spillover effects into CUA. The most common method was to sum children's and parents/caregivers' QALYs. Only two studies used a theoretical framework for incorporation of family spillover effects. CONCLUSIONS Few pediatric CUAs included family spillover effects and the observed variation indicated no consensus among researchers on how family spillover effects should be measured and incorporated. This heterogeneity is mirrored by a lack of practical guidelines by Health Technology Assessment (HTA) agencies or a theoretical foundation for including family spillover effects in pediatric CUA. The results from this review may encourage researchers to develop a theoretical framework and HTA agencies to develop guidelines for including family spillover effects. Such guidance may lead to more rigorous and standardized methods for including family spillover effects and better-quality evidence to inform decision-makers on the cost-effectiveness of pediatric health interventions.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Mohy A, Page N, Boyce W, Gomez JA. Economic Evaluation of Rotavirus Vaccination in Children Aged Under Five Years in South Africa. Clin Drug Investig 2023; 43:851-863. [PMID: 37831397 PMCID: PMC10632264 DOI: 10.1007/s40261-023-01312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme. METHODS Cost and cost-effectiveness analyses were conducted to compare three rotavirus vaccines using a static, deterministic, population model in children aged <5 years in South Africa from country payer and societal perspectives. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. RESULTS The human rotavirus, live, attenuated, oral vaccine (HRV) was associated with cost savings versus HBRV from both perspectives, and versus BRV-PV 1-dose vial from the societal perspective. In the cost-effectiveness analysis, HRV was estimated to avoid 1,107 home care rotavirus gastroenteritis (RVGE) events, 247 medical visits, 35 hospitalisations, and 4 RVGE-related deaths versus HBRV and BRV-PV. This translated to 73 quality-adjusted life years gained. HRV was associated with lower costs versus HBRV from both payer (-$3.9M) and societal (-$11.5M) perspectives and versus BRV-PV 1-dose vial from the societal perspective (-$3.8M), dominating those options. HRV was associated with higher costs versus BRV-PV 1-dose vial from the payer perspective and versus BRV-PV 2‑dose vial from both payer and societal perspectives (ICERs: $51,834, $121,171, and $16,717, respectively), exceeding the assumed cost-effectiveness threshold of 0.5 GDP per capita. CONCLUSION Vaccination with a 2-dose schedule of HRV may lead to better health outcomes for children in South Africa compared with the 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- GSK, Value Evidence and Outcomes, Emerging Markets, GSK Vaccines, Wavre, Belgium.
| | - Nicola Page
- Center for Enteric Diseases, National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Jorge A Gomez
- GSK, Value Evidence and Outcomes, Emerging Markets, Buenos Aires, Argentina
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Gomez J, Velázquez FR, Guzman-Holst A, Cervantes Apolinar MY, Van Bellinghen LA, Van Vlaenderen I, van Oorschot D. Cost-effectiveness analysis measuring the total costs against the health benefits of three different rotavirus vaccines for Mexico. Hum Vaccin Immunother 2023:2219189. [PMID: 37339232 DOI: 10.1080/21645515.2023.2219189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/22/2023] Open
Abstract
Rotavirus (RV) infection causes acute rotavirus gastroenteritis (RVGE) in infants. Safe and effective RV vaccines are available, of which Mexico has included one in its national immunization program (NIP) since 2007. Health outcome gains, expressed in quality-adjusted life years (QALYs), and cost improvements are important additional factors for the selection of a NIP vaccine. These two factors were analyzed here for Mexico over one year implementing three RV vaccines: 2-dose Rotarix (HRV), versus 3-dose RotaTeq (HBRV), and 3-dose Rotasiil (BRV-PV), presented in a 1-dose or 2-dose vial). HRV would annually result in discounted QALY gains of 263 extra years compared with the other vaccines by averting an extra 24,022 homecare cases, 10779 medical visits, 392 hospitalizations, and 12 deaths. From a payer's perspective and compared with HRV, BRV-PV 2-dose vial and BRV-PV 1-dose vial would annually result in $13.5 million and $4.6 million net savings, respectively, while HBRV would result in $3.4 million extra costs. The societal perspective may also show savings compared with HRV for BRV-PV 2-dose vial of $4.9 million, while BRV-PV 1-dose vial and HBRV may show extra costs of $4.0 million and $12.1 million respectively. HRV and HBRV were both approved in Mexico, with HRV requiring less investment than HBRV with higher QALY gains and cost savings. The HRV vaccine produced those higher health gains due to its earlier protection and greater coverage achieved after its schedule completion with two doses only, providing full protection at four months of age instead of longer periods for the other vaccines.
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Murphy A, Kirby A, De Blasio F. The economic impact of the introduction of universal rotavirus vaccination on rotavirus gastroenteritis related hospitalisations in children in Ireland. Vaccine 2023; 41:2656-2663. [PMID: 36948981 DOI: 10.1016/j.vaccine.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/20/2023] [Accepted: 03/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Rotavirus gastroenteritis (RVGE), a vaccine preventable disease, remains a common cause of severe gastroenteritis in children globally. Ireland introduced the universal rotavirus vaccination to the national immunisation programme in 2016. In this paper the economic impact on RVGE related hospitalisations amongst children under 5 years is examined. METHODS Using national data from all Irish public hospitals, an Interrupted Times Series Analysis (ITSA) compares RVGE hospitalisations amongst children under 5 years, pre- and post-vaccine introduction. Costs are estimated and ITSA results are compared to the counterfactual to estimate the economic impact of the vaccine. A probit model examines patient characteristics pre- and post-vaccine introduction. RESULTS Vaccine introduction coincided with lowered RVGE related hospitalisations. While this effect was delayed (1 year) there is evidence of a sustained impact. RVGE patients' post-vaccine introduction were likely to be over 2 years (p = 0.001) and length of stay was lower on average (p = 0.095). The counterfactual analysis revealed 492 RVGE hospitalisations were avoided on average annually since the introduction of the vaccine. This has an estimated economic value of €0.92 million per annum. CONCLUSIONS Following the introduction of the rotavirus vaccine in Ireland, hospitalisations for RVGE decreased significantly and those hospitalised were older and with a reduced length of stay on average. This has the potential for significant cost savings for the Irish healthcare system.
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Affiliation(s)
- Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Ireland
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, Ireland.
| | - Federica De Blasio
- Department of Economics, Cork University Business School, University College Cork, Ireland
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Scope A, Bhadhuri A, Pennington B. Systematic Review of Cost-Utility Analyses That Have Included Carer and Family Member Health-Related Quality of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1644-1653. [PMID: 35339379 DOI: 10.1016/j.jval.2022.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Health interventions for patients can also affect the health of their informal carers and family members. These changes in carer or family member health could be reflected in cost-utility analyses (CUAs) through the inclusion of their quality-adjusted life-years (QALYs). We conducted a systematic review to identify and describe all CUAs that have included family member health-related QALYs. METHODS A total of 4 bibliographic databases were searched from inception to July 2021. A 2-stage sifting process for inclusion of studies was undertaken. We performed data extraction using a standardized data extraction form and performed a narrative synthesis of the evidence. RESULTS A total of 40 CUAs published between 1999 and 2021 were identified. CUAs were conducted in 15 different countries. CUAs examined 13 different conditions including 15 CUAs on vaccination, 5 on Alzheimer's disease, 2 on Parkinson's disease, 3 on dementia, and 2 on terminal illness. The EQ-5D was the most commonly used measure of family member health. Generally, including carer QALYs resulted in lower incremental cost-effectiveness ratios. CONCLUSIONS When considering the total number of economic evaluations published, few have included family member QALYs and the methods for doing so are often inconsistent and data sources often limited. Estimation of family member QALYs in patient CUAs was regularly uncertain and often substantial in magnitude. The findings highlight the variation among methods and call for greater consistency in methods for incorporating family member QALYs in patient CUAs.
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Affiliation(s)
- Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Arjun Bhadhuri
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
| | - Becky Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
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Regional hospitalisation and seasonal variations of Pediatric rotavirus gastroenteritis pre- and post-RV vaccination: a prospective and retrospective study. World J Pediatr 2022; 18:404-416. [PMID: 35435638 DOI: 10.1007/s12519-022-00546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Rotavirus is the primary cause of gastroenteritis in children worldwide and is a leading cause of gastroenteritis in children, with a significant burden. Rotavirus vaccine became available in Ireland in 2016. This study aimed to investigate hospital admissions and seasonal characteristics of rotavirus gastroenteritis in a pre- and post-vaccination period in a single district general hospital. METHODS In the post-vaccination year, from November 18th 2016 to November 18th 2017, all children up to 3 years of age who presented to Mayo University Hospital with vomiting and diarrhea, were recruited and had their stool tested for rotavirus. Retrospective analysis of hospital data of children of the same age during pre-vaccination years (2014-2016) were used for comparison. RESULTS Compared with the pre-vaccination years (2014-2016), the median percentages of reduction of rotavirus positive stool requests and hospital admissions were high, 48.5% and 73%, respectively. In the post-vaccination year, the median percentage of reduction of emergency department presentation (stool requests) with gastroenteritis was 9%. No delay in the onset of RV season or reduction of the peak of RV infection was noted in the post-vaccination year. The duration of rotavirus season in 2016/2017 was short. CONCLUSIONS Compared with 3 pre-vaccination years, the total number of gastroenteritis presentations, gastroenteritis hospital admissions, and rotavirus positive gastroenteritis cases were all reduced, and the duration of the rotavirus season was shorter.
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Rochanathimoke O, Riewpaiboon A, Praditsitthikorn N, Tharmaphornpilas P, Jiamsiri S, Thavorncharoensap M, Postma MJ. Economic evaluation of rotavirus vaccination: an important step of the introduction to the national immunization program in Thailand. Expert Rev Pharmacoecon Outcomes Res 2021; 21:811-819. [PMID: 34008471 DOI: 10.1080/14737167.2021.1932468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION World Health Organization recommends rotavirus vaccine for all national immunization programs (NIPs). To provide country-specific evidence, we conducted economic evaluation of a monovalent rotavirus vaccination using specific data of the pilot phase in Thailand. METHOD A Markov model was adopted to compare the 2020 birth cohort once receiving rotavirus vaccination versus no vaccination from healthcare and societal perspective over five years. Data on disease burden, vaccine effectiveness, costs, and utilities were taken from a cohort study in two provinces of Thailand. Sensitivity analyses were performed to test the robustness of the results. RESULTS Rotavirus vaccination would reduce rotavirus diarrhea and costs of illness by 48% and 71%, respectively, over the first five years of life. At USD 13 per dose, vaccine was cost-effective with the ICERs of USD 4,114 and USD 1,571per QALY gained from healthcare and societal perspective, respectively. Results were sensitive to incidence and vaccine cost. The budget for vaccine purchasing was estimated at USD13 million per year. CONCLUSION Incorporating rotavirus vaccination into the NIP substantially reduced health and cost outcomes and was cost-effective for both perspectives. However, the government needs to negotiate vaccine price prior to program implementation to achieve favorable budget impact.
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Affiliation(s)
- Onwipa Rochanathimoke
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | | | - Suchada Jiamsiri
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Maarten J Postma
- Unit of PharmacoTherapy, -epidemiology & -economics, University of Groningen, Groningen Research Institute of Pharmacy (GRIP), Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga-Soetomo Hospital, Surabaya, Indonesia
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Lu Y, Xie H, Wang D, Lu J. An outbreak of rotavirus-related acute gastroenteritis of childcare center in Guangzhou, southern China. Hum Vaccin Immunother 2021; 17:2814-2815. [PMID: 33710946 DOI: 10.1080/21645515.2021.1898308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Rotavirus is the most common cause of severe diarrhea in children under 5 y old in the world. The study aims to explore the relationship between rotavirus vaccination and infection in the outbreak of rotavirus gastroenteritis in a childcare center. Earlier immunization and high vaccination rate should be encouraged.
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Affiliation(s)
- Ying Lu
- Department for Infectious Diseases Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huaping Xie
- Department of Virology and Immunology, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Dahu Wang
- Department for Infectious Diseases Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jianyun Lu
- Department for Infectious Diseases Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
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Pempa, Luz ACG, Luangasanatip N, Kingkaew P, Adhikari D, Isaranuwatchai W, Choiphel D, Pecenka C, Debellut F. Economic evaluation of rotavirus vaccination in children of Bhutan. Vaccine 2020; 38:5049-5059. [PMID: 32522415 PMCID: PMC7327517 DOI: 10.1016/j.vaccine.2020.05.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022]
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.
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Affiliation(s)
- Pempa
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
| | - Alia Cynthia G Luz
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand
| | - Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand.
| | - Deepika Adhikari
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Dechen Choiphel
- Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan
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Coveney J, Barrett M, Fitzpatrick P, Kandamany N, Mcnamara R, Koe S, Okafor I. National rotavirus vaccination programme implementation and gastroenteritis presentations: the paediatric emergency medicine perspective. Ir J Med Sci 2019; 189:327-332. [PMID: 31197576 DOI: 10.1007/s11845-019-02046-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Throughout the developed world, the introduction of rotavirus vaccination has led to reductions in the incidence and severity of acute gastroenteritis (AGE) in young children and consequently to reductions in paediatric emergency department (PED) attendances with AGE. Rotavirus vaccination was added to the Irish National Immunisation Schedule in November 2016. AIMS To assess the impact of vaccine introduction on citywide PED attendances and hospital admissions with all-cause AGE during rotavirus season. METHODS In an observational study, a retrospective search was performed of electronic records in three independent PEDs in Dublin. Weekly presentations and admissions with AGE in the first 30 weeks (gastroenteritis season) of the years 2012-2018 were counted and stratified by age. RESULTS Median weekly presentations in 2017-2018, 126 (interquartile range (IQR) 103-165) were significantly lower than in 2012-2016, 160 (IQR 128-214) (p < 0.001). A reduction in presentations was seen across the three hospitals and in those aged less than 5 years. In one PED, median admissions in 2017-2018 were 10 (IQR 7-13) in comparison with nine (IQR 7-13) in 2012-2016, (p = 0.463). The emergency department AGE presentations to hospital ward admission rate was 6.7:1. CONCLUSION A reduction in PED presentations with AGE is demonstrated post-rotavirus vaccine introduction into the Irish National Immunisation Schedule. No significant change in paediatric hospital admissions was demonstrated.
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Affiliation(s)
- John Coveney
- Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland.
| | - Michael Barrett
- Emergency Department, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.,Women's & Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Patrick Fitzpatrick
- Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland
| | - Nandini Kandamany
- Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland
| | - Roisin Mcnamara
- Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland
| | - Stanley Koe
- Emergency Department, Incorporating the National Children's Hospital, Tallaght University Hospital, Dublin, Ireland
| | - Ikechukwu Okafor
- Emergency Department, Temple Street Children's University Hospital, Dublin, Ireland
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Freeman K, Mistry H, Tsertsvadze A, Royle P, McCarthy N, Taylor-Phillips S, Manuel R, Mason J. Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis. Health Technol Assess 2018; 21:1-188. [PMID: 28619124 DOI: 10.3310/hta21230] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. OBJECTIVE To systematically review the evidence for GPP tests [xTAG® (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales. DATA SOURCES Multiple electronic databases including MEDLINE, EMBASE, Web of Science and the Cochrane Database were searched from inception to January 2016 (with supplementary searches of other online resources). REVIEW METHODS Eligible studies included patients with acute diarrhoea; comparing GPP tests with standard microbiology techniques; and patient, management, test accuracy or cost-effectiveness outcomes. Quality assessment of eligible studies used tailored Quality Assessment of Diagnostic Accuracy Studies-2, Consolidated Health Economic Evaluation Reporting Standards and Philips checklists. The meta-analysis included positive and negative agreement estimated for each pathogen. A de novo decision tree model compared patients managed with GPP testing or comparable coverage with patients managed using conventional tests, within the Public Health England pathway. Economic models included hospital and community management of patients with suspected gastroenteritis. The model estimated costs (in 2014/15 prices) and quality-adjusted life-year losses from a NHS and Personal Social Services perspective. RESULTS Twenty-three studies informed the review of clinical evidence (17 xTAG, four FilmArray, two xTAG and FilmArray, 0 Faecal Pathogens B). No study provided an adequate reference standard with which to compare the test accuracy of GPP with conventional tests. A meta-analysis (of 10 studies) found considerable heterogeneity; however, GPP testing produces a greater number of pathogen-positive findings than conventional testing. It is unclear whether or not these additional 'positives' are clinically important. The review identified no robust evidence to inform consequent clinical management of patients. There is considerable uncertainty about the cost-effectiveness of GPP panels used to test for suspected infectious gastroenteritis in hospital and community settings. Uncertainties in the model include length of stay, assumptions about false-positive findings and the costs of tests. Although there is potential for cost-effectiveness in both settings, key modelling assumptions need to be verified and model findings remain tentative. LIMITATIONS No test-treat trials were retrieved. The economic model reflects one pattern of care, which will vary across the NHS. CONCLUSIONS The systematic review and cost-effectiveness model identify uncertainties about the adoption of GPP tests within the NHS. GPP testing will generally correctly identify pathogens identified by conventional testing; however, these tests also generate considerable additional positive results of uncertain clinical importance. FUTURE WORK An independent reference standard may not exist to evaluate alternative approaches to testing. A test-treat trial might ascertain whether or not additional GPP 'positives' are clinically important or result in overdiagnoses, whether or not earlier diagnosis leads to earlier discharge in patients and what the health consequences of earlier intervention are. Future work might also consider the public health impact of different testing treatments, as test results form the basis for public health surveillance. STUDY REGISTRATION This study is registered as PROSPERO CRD2016033320. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Karoline Freeman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Tsertsvadze
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Pam Royle
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Noel McCarthy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - James Mason
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Tran AN, Husberg M, Bennet R, Brytting M, Carlsson P, Eriksson M, Storsaeter J, Österlin B, Johansen K. Impact on affected families and society of severe rotavirus infections in Swedish children assessed in a prospective cohort study. Infect Dis (Lond) 2017; 50:361-371. [PMID: 29260605 DOI: 10.1080/23744235.2017.1416162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Few prospective cohort studies have estimated the overall impact of severe rotavirus gastroenteritis (RVGE) leading to hospitalization on families and society. We assessed human and economic resources needed to care for an affected average child aged <5 years in Sweden. METHODS The study was conducted in Astrid Lindgren Children's Hospital which serves approximately 14% of all Swedish children <5 years of age. All children admitted with acute gastroenteritis in the study period were tested for rotavirus. Health care consumption was collected prospectively and publically available unit costs used to calculate direct costs. Non-medical and indirect costs were collected in interviews with families using a standardized questionnaire during the hospital stay and approximately 14 days post-discharge. RESULTS 144/206 children (70%) with laboratory-confirmed RVGE were included. The median age was 14 months. The average total cost per hospitalized child was €3894, of which €2169 (56%) was due to direct healthcare-related costs (including Emergency Department visits and in-patient care), €104 (2%) to non-medical direct costs and €1621 (42%) to indirect costs due to productivity loss. Carers of children with severe RVGE were absent from work on average five days per study child: four days during hospitalization of affected child and one day due to gastroenteritis in the carer. CONCLUSIONS Costs for RVGE are dominated by direct costs which are similar to some other countries in Europe, but indirect costs due to productivity loss are also important, and should be considered in decisions to introduce rotavirus vaccines into national vaccination programmes.
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Affiliation(s)
- Anh Nhi Tran
- a Department of Microbiology , Public Health Agency of Sweden , Solna , Sweden
| | - Magnus Husberg
- b Center for Medical Technology Assessment, Department of Medicine and Health , Linköping University , Linköping , Sweden
| | - Rutger Bennet
- c Department of Woman and Child Health , Astrid Lindgren Children´s Hospital, Karolinska University Hospital , Stockholm , Sweden
| | - Maria Brytting
- a Department of Microbiology , Public Health Agency of Sweden , Solna , Sweden
| | - Per Carlsson
- b Center for Medical Technology Assessment, Department of Medicine and Health , Linköping University , Linköping , Sweden
| | - Margareta Eriksson
- c Department of Woman and Child Health , Astrid Lindgren Children´s Hospital, Karolinska University Hospital , Stockholm , Sweden
| | - Jann Storsaeter
- d Department of Vaccine-Preventable Illnesses , National Public Health Institute , Oslo , Norway
| | - Barbro Österlin
- a Department of Microbiology , Public Health Agency of Sweden , Solna , Sweden
| | - Kari Johansen
- a Department of Microbiology , Public Health Agency of Sweden , Solna , Sweden
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Leino T, Baum U, Scott P, Ollgren J, Salo H. Impact of five years of rotavirus vaccination in Finland – And the associated cost savings in secondary healthcare. Vaccine 2017; 35:5611-5617. [DOI: 10.1016/j.vaccine.2017.08.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/30/2022]
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Kotirum S, Vutipongsatorn N, Kongpakwattana K, Hutubessy R, Chaiyakunapruk N. Global economic evaluations of rotavirus vaccines: A systematic review. Vaccine 2017; 35:3364-3386. [PMID: 28504193 DOI: 10.1016/j.vaccine.2017.04.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted. METHODS We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs. RESULTS 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings. CONCLUSION Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.
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Affiliation(s)
- Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Social and Administrative Pharmacy Department, Faculty of Pharmacy, Rangsit University, Muang, Pathumthani, Thailand
| | - Naaon Vutipongsatorn
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Raymond Hutubessy
- World Health Organization, Initiative for Vaccine Research, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; Health and Well-being Cluster, Global Asia in the 21(st) Centuary (GA21) Platform, Monash University Malaysia, Selangor, Malaysia.
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Yandle Z, Coughlan S, Drew RJ, O’Flaherty N, O’Gorman J, De Gascun C. Circulating rotavirus genotypes in the Irish paediatric population prior to the introduction of the vaccination programme. Ir J Med Sci 2017; 186:1003-1007. [DOI: 10.1007/s11845-017-1604-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/24/2017] [Indexed: 02/07/2023]
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17
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Usher C, Adams R, Schmitz S, Kieran J, O'Flanagan D, O'Donnell J, Connolly K, Corcoran B, Butler K, Barry M, Walsh C. Evaluating the neonatal BCG vaccination programme in Ireland. ACTA ACUST UNITED AC 2016; 74:28. [PMID: 27413531 PMCID: PMC4942954 DOI: 10.1186/s13690-016-0141-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022]
Abstract
Background The aim of this study was to compare the cost effectiveness of the current Irish programme of universal BCG vaccination of infants versus a programme which considered selectively vaccinating high risk infants using decision analytical modelling. Methods The efficacy of the BCG vaccine was re-evaluated to inform a decision analytical model constructed to follow a birth cohort of vaccinated and unvaccinated infants over a 15 year time horizon. The number of life years gained (LYG) was the primary outcome measure and this was compared to the net cost of the vaccination strategies. Results In the base case analysis, the incremental cost effectiveness ratios (ICERs) for the universal strategy and selective strategy vs no vaccination were €204,373/LYG and €143,233/LYG respectively. When comparing the incremental difference in moving from the universal to the selective strategy, the selective strategy costs €1,055,692 less per 4.8 life years lost per birth cohort. One way sensitivity analyses highlighted that a move from the universal to the selective strategy was particularly sensitive to the estimate of vaccine efficacy against deaths, the cost of administering the vaccine and the multiplier used to apportion risk of contracting tuberculosis. Probabilistic analysis suggested that a move from a universal based strategy to a selective based strategy could be deemed cost effective (probability of cost effectiveness is 76.8 %). Conclusion The results of the study support the protective effect of the BCG vaccine in infants and quantified the cost effectiveness of the current BCG vaccination strategy and the decremental difference in moving to a selective strategy. This analysis highlights that the additional protection offered by the universal vaccination strategy is small compared to that of the selective strategy. Consideration should therefore be given to the implementation of a selective vaccination strategy, and diverting resources to improve TB case management and control. Electronic supplementary material The online version of this article (doi:10.1186/s13690-016-0141-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cara Usher
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
| | - Roisin Adams
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland
| | - Susanne Schmitz
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Jennifer Kieran
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Darina O'Flanagan
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Joan O'Donnell
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Kevin Connolly
- Health Protection Surveillance Centre, Dublin 1, Ireland ; National Immunisation Advisory Committee, Dublin 2, Ireland
| | - Brenda Corcoran
- National Immunisation Advisory Committee, Dublin 2, Ireland ; National Immunisation Office, Dublin 7, Ireland
| | - Karina Butler
- National Immunisation Advisory Committee, Dublin 2, Ireland ; Department of Infectious Diseases, Our Lady's Childrens Hospital, Crumlin, Dublin 12, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Pharmacology & Therapeutics, Trinity Centre, St. James's Hospital, Dublin 8, Ireland
| | - Cathal Walsh
- National Centre for Pharmacoeconomics, St. James's Hospital, Dublin 8, Ireland ; Department of Maths & Statistics, Centre for Health Decision Sciences (CHeDS), University of Limerick, Limerick, Ireland
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Herdman M, Cole A, Hoyle CK, Coles V, Carroll S, Devlin N. Sources and Characteristics of Utility Weights for Economic Evaluation of Pediatric Vaccines: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:255-266. [PMID: 27021761 DOI: 10.1016/j.jval.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/31/2015] [Accepted: 11/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cost-effectiveness analysis of pediatric vaccines for infectious diseases often requires quality-of-life (utility) weights. OBJECTIVE To investigate how utility weights have been elicited and used in this context. METHODS A systematic review was conducted of studies published between January 1990 and July 2013 that elicited or used utility weights in cost-effectiveness analyses of vaccines for pediatric populations. The review focused on vaccines for 17 infectious diseases and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. RESULTS A total of 6410 titles and abstracts and 225 full-text articles were reviewed. Of those selected for inclusion (n = 101), 15 articles described the elicitation of utility weights and 86 described economic modeling studies using utilities. Various methods were used to generate utilities, including time trade-off, contingent valuation, and willingness to pay, as well as a preference-based measure with associated value sets, such as the EuroQol five-dimensional questionnaire or the Health Utilities Index. In modeling studies, the source of utilities used was often unclear, poorly reported, or based on weak underlying evidence. We found no articles that reported on the elicitation or use of utilities in diphtheria, polio, or tetanus. CONCLUSIONS The scarcity of appropriate utility weights for vaccine-preventable infectious diseases in children and a lack of standardization in their use in economic assessments limit the ability to accurately assess the benefits associated with interventions to prevent infectious diseases. This is an issue that should be of concern to those making decisions regarding the prevention and treatment of infectious childhood illnesses.
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Rotavirus vaccines: a story of success. Clin Microbiol Infect 2015; 21:735-43. [DOI: 10.1016/j.cmi.2015.01.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
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Collins P, Mulherin E, O'Shea H, Cashman O, Lennon G, Pidgeon E, Coughlan S, Hall W, Fanning S. Changing patterns of rotavirus strains circulating in Ireland: Re-emergence of G2P[4] and identification of novel genotypes in Ireland. J Med Virol 2015; 87:764-73. [DOI: 10.1002/jmv.24095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- P.J. Collins
- Department of Biological Sciences; Cork Institute of Technology; Cork Ireland
| | - Emily Mulherin
- UCD-Centre for Food Safety; School of Public Health; Physiotherapy and Population Science; Dublin Ireland
| | - Helen O'Shea
- Department of Biological Sciences; Cork Institute of Technology; Cork Ireland
| | - Olivia Cashman
- Department of Biological Sciences; Cork Institute of Technology; Cork Ireland
| | - Grainne Lennon
- Department of Biological Sciences; Cork Institute of Technology; Cork Ireland
| | - Eugene Pidgeon
- National Virus Reference Laboratory; University College Dublin; Dublin Ireland
| | - Suzie Coughlan
- National Virus Reference Laboratory; University College Dublin; Dublin Ireland
| | - William Hall
- National Virus Reference Laboratory; University College Dublin; Dublin Ireland
| | - Séamus Fanning
- UCD-Centre for Food Safety; School of Public Health; Physiotherapy and Population Science; Dublin Ireland
- School of Veterinary Medicine; University College Dublin; Dublin Ireland
- Institute for Global Food Security; Queen's University Belfast; Belfast Ireland
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Alkoshi S, Maimaiti N, Dahlui M. Cost-effectiveness analysis of rotavirus vaccination among Libyan children using a simple economic model. Libyan J Med 2014; 9:26236. [PMID: 25499622 PMCID: PMC4262756 DOI: 10.3402/ljm.v9.26236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotavirus infection is a major cause of childhood diarrhea in Libya. The objective of this study is to evaluate the cost-effectiveness of rotavirus vaccination in that country. METHODS We used a published decision tree model that has been adapted to the Libyan situation to analyze a birth cohort of 160,000 children. The evaluation of diarrhea events in three public hospitals helped to estimate the rotavirus burden. The economic analysis was done from two perspectives: health care provider and societal. Univariate sensitivity analyses were conducted to assess uncertainty in some values of the variables selected. RESULTS The three hospitals received 545 diarrhea patients aged≤5 with 311 (57%) rotavirus positive test results during a 9-month period. The societal cost for treatment of a case of rotavirus diarrhea was estimated at US$ 661/event. The incremental cost-effectiveness ratio with a vaccine price of US$ 27 per course was US$ 8,972 per quality-adjusted life year gained from the health care perspective. From a societal perspective, the analysis shows cost savings of around US$ 16 per child. CONCLUSION The model shows that rotavirus vaccination could be economically a very attractive intervention in Libya.
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Affiliation(s)
- Salem Alkoshi
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
| | - Namaitijiang Maimaiti
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
Rotavirus gastroenteritis is a vaccine-preventable disease that confers a high medical and economic burden in more developed countries and can be fatal in less developed countries. Two vaccines with high efficacy and good safety profiles were approved and made available in Europe in 2006. We present an overview of the status of rotavirus vaccination in Europe. We discuss the drivers (including high effectiveness and effect of universal rotavirus vaccination) and barriers (including low awareness of disease burden, perception of unfavourable cost-effectiveness, and potential safety concerns) to the implementation of universal rotavirus vaccination in Europe. By February, 2014, national universal rotavirus vaccination had been implemented in Belgium, Luxembourg, Austria, Finland, Greece, Luxembourg, Norway, and the UK. Four other German states have issued recommendations and reimbursement is provided by sickness funds. Other countries were at various stages of recommending or implementing universal rotavirus vaccination.
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Rheingans R, Amaya M, Anderson JD, Chakraborty P, Atem J. Systematic review of the economic value of diarrheal vaccines. Hum Vaccin Immunother 2014; 10:1582-94. [PMID: 24861846 PMCID: PMC5396238 DOI: 10.4161/hv.29352] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/24/2014] [Indexed: 01/23/2023] Open
Abstract
Diarrheal disease is a leading cause of child mortality in low-income settings and morbidity across a range of settings. A growing number of studies have addressed the economic value of new and emerging vaccines to reduce this threat. We conducted a systematic review to assess the economic value of diarrheal vaccines targeting a range of pathogens in different settings. The majority of studies focused on the economic value of rotavirus vaccines in different settings, with most of these concluding that vaccination would provide significant economic benefits across a range of vaccine prices. There is also evidence of the economic benefits of cholera vaccines in specific contexts. For other potential diarrheal vaccines data are limited and often hypothetical. Across all target pathogens and contexts, the evidence of economic value focuses the short-term health and economic gains. Additional information is needed on the broader social and long-term economic value of diarrhea vaccines.
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Affiliation(s)
- Richard Rheingans
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - Mirna Amaya
- Department of Health Services Research, Management & Policy; College of Public Health and Health Professions; University of Florida; Gainesville, FL USA
| | - John D Anderson
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Poulomy Chakraborty
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
| | - Jacob Atem
- Department of Environmental and Global Health; Emerging Pathogens Institute; University of Florida; Gainesville, FL USA
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Álvarez Aldeán J, Aristegui J, López-Belmonte JL, Pedrós M, Sicilia JG. Economic and psychosocial impact of rotavirus infection in Spain: a literature review. Vaccine 2014; 32:3740-51. [PMID: 24837768 DOI: 10.1016/j.vaccine.2014.04.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
Severe rotavirus gastroenteritis is common in children under 5 years of age. A literature review was performed to investigate the economic and psychosocial impact of rotavirus infection in children in this age group. We retrieved 56 articles on the economic burden of the disease in Europe, 18 of them reported data from Spain; 8 articles were retrieved analysing its psychosocial impact. In Spain, rotavirus is responsible for 14% to 30% of all cases of gastroenteritis, and a quarter of these require hospitalisation. It is also associated with high use of health care resources (emergency and primary care visits). Rotavirus gastroenteritis costs the Spanish national health system EUR 28 million a year and causes productivity loss in two-thirds of parents (mean of 4 days). Taking into account these costs, it was estimated that implementing universal vaccination could prevent 76% to 95% of hospital admissions due to rotavirus gastroenteritis, as well as reduce emergency and paediatric visits, nosocomial infections, and days missed from work (77% reduction). Rotavirus gastroenteritis also has a considerable psychosocial impact on the family, although it is difficult to compare results due to the diversity of study designs and the low specificity of the measurement tools used. It also causes high stress among parents, adding to their workload and adversely affecting their quality of life.
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Imaz I, Rubio B, Cornejo AM, González-Enríquez J. Budget impact and cost-utility analysis of universal infant rotavirus vaccination in Spain. Prev Med 2014; 61:116-21. [PMID: 24360847 DOI: 10.1016/j.ypmed.2013.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 02/07/2023]
Abstract
Rotavirus is not included in the Spanish mass infant vaccination schedule but has also not been economically evaluated for its inclusion. We analysed cost-utility of the universal infant rotavirus vaccination using RotaTeq® versus no vaccination in Spain. We also carried out a budget impact analysis and determined the effect on results of different variables introduced in the model. A deterministic Markov model was built considering loss of quality of life for children and their parents, and introducing direct and indirect costs updated to 2011. The introduction of the vaccination using RotaTeq® as a universal infant vaccination would increase the annual health care budget in 10.43 million euro and would result in a gain of an additional Quality Adjusted Life Year at a cost of 280,338€ from the healthcare system perspective and 210,167€ from the societal perspective. The model was stable to variable modifications. To sum up, according to our model and estimates, the introduction of a universal infant rotavirus vaccination with RotaTeq® in Spain would cause a large impact on the health care budget and would not be efficient unless significant variations in vaccine price, vaccine efficacy and/or utilities took place.
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Affiliation(s)
- Iñaki Imaz
- Spanish Health Technology Assessment Agency (AETS-Agencia de Evaluación de Tecnologías Sanitarias), Institute for Health "Carlos III", 5 Monforte de Lemos, Madrid 28029, Spain; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas-Spanish Health Services Research on Cronic Patients Network), Spain.
| | - Beltrán Rubio
- Spanish Health Technology Assessment Agency (AETS-Agencia de Evaluación de Tecnologías Sanitarias), Institute for Health "Carlos III", 5 Monforte de Lemos, Madrid 28029, Spain
| | - Ana M Cornejo
- Preventive Medicine Department, "Ramón y Cajal" Universitary Hospital, Ctra. de Colmenar Viejo km. 9,100, Madrid 28034, Spain.
| | - Jesús González-Enríquez
- Spanish Health Technology Assessment Agency (AETS-Agencia de Evaluación de Tecnologías Sanitarias), Institute for Health "Carlos III", 5 Monforte de Lemos, Madrid 28029, Spain; REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas-Spanish Health Services Research on Cronic Patients Network), Spain.
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Aidelsburger P, Grabein K, Böhm K, Dietl M, Wasem J, Koch J, Ultsch B, Weidemann F, Wichmann O. Cost-effectiveness of childhood rotavirus vaccination in Germany. Vaccine 2014; 32:1964-74. [DOI: 10.1016/j.vaccine.2014.01.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 12/17/2013] [Accepted: 01/22/2014] [Indexed: 11/29/2022]
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De la Hoz-Restrepo F, Castañeda-Orjuela C, Paternina A, Alvis-Guzman N. Systematic review of incremental non-vaccine cost estimates used in cost-effectiveness analysis on the introduction of rotavirus and pneumococcal vaccines. Vaccine 2014; 31 Suppl 3:C80-7. [PMID: 23777697 DOI: 10.1016/j.vaccine.2013.05.064] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 05/01/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the approaches used in the cost-effectiveness analysis (CEAs) literature to estimate the cost of expanded program on immunization (EPI) activities, other than vaccine purchase, for rotavirus and pneumococcal vaccines. METHODS A systematic review in PubMed and NHS EED databases of rotavirus and pneumococcal vaccines CEAs was done. Selected articles were read and information on how EPI costs were calculated was extracted. EPI costing approaches were classified according to the method or assumption used for estimation. RESULTS Seventy-nine studies that evaluated cost effectiveness of rotavirus (n=43) or pneumococcal (n=36) vaccines were identified. In general, there are few details on how EPI costs other than vaccine procurement were estimated. While 30 studies used some measurement of that cost, only one study on pneumococcal vaccine used a primary cost evaluation (bottom-up costing analysis) and one study used a costing tool. Twenty-seven studies (17 on rotavirus and 10 on pneumococcal vaccine) assumed the non-vaccine costs. Five studies made no reference to additional costs. Fourteen studies (9 rotavirus and 5 pneumococcal) did not consider any additional EPI cost beyond vaccine procurement. For rotavirus studies, the median for non-vaccine cost per dose was US$0.74 in developing countries and US$6.39 in developed countries. For pneumococcal vaccines, the median for non-vaccine cost per dose was US$1.27 in developing countries and US$8.71 in developed countries. CONCLUSIONS Many pneumococcal (52.8%) and rotavirus (60.4%) cost-effectiveness analyses did not consider additional EPI costs or used poorly supported assumptions. Ignoring EPI costs in addition to those for vaccine procurement in CEA analysis of new vaccines may lead to significant errors in the estimations of ICERs since several factors like personnel, cold chain, or social mobilization can be substantially affected by the introduction of new vaccines.
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Bruijning-Verhagen P, Mangen MJJ, Felderhof M, Hartwig NG, van Houten M, Winkel L, de Waal WJ, Bonten MJM. Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal vaccination. BMC Med 2013; 11:112. [PMID: 23622110 PMCID: PMC3665442 DOI: 10.1186/1741-7015-11-112] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/09/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The cost-effectiveness of universal rotavirus (RV) vaccination is controversial in developed countries. As a result, RV vaccination programs do not currently exist in most European countries. Hospitalization is the main driver of RV disease costs, and prematurity, low birth weight (LBW) and underlying medical conditions have been associated with RV hospitalization and complications. We investigated the cost-effectiveness of targeted RV vaccination of high-risk infants and universal RV vaccination versus no vaccination. METHODS Disease burden, mortality and healthcare costs of RV hospitalization for children with and without prematurity, LBW and congenital pathology were quantified in two hospital-based observational studies in the Netherlands. Cost-effectiveness analysis was based on an age-structured stochastic multi-cohort model of the Dutch population comparing universal RV vaccination and targeted vaccination of high-risk infants to no vaccination. The primary endpoint was the incremental cost-effectiveness ratio (ICER), with a threshold of €35,000/quality-adjusted life year (QALY) from the healthcare provider perspective. Sensitivity analyses included vaccine price and coverage, herd-immunity and QALY losses. RESULTS A total of 936 children with RV infection were included. Prematurity, LBW and congenital pathology were associated with increased risks of RV hospitalization (relative risks (RR) ranging from 1.6 to 4.4), ICU admission (RR ranging from 4.2 to 7.9), prolonged hospital stay (1.5 to 3.0 excess days) and higher healthcare costs (€648 to €1,533 excess costs). Seven children succumbed due to RV complications, all belonging to the high-risk population. Targeted RV vaccination was highly cost-effective and potentially cost-saving from the healthcare provider perspective with ICERs below €20,000/QALY in all scenarios with total (undiscounted) annual healthcare costs between -€0.1 and €0.5 million/year. Results were most sensitive to mortality rates, but targeted vaccination remained highly cost-effective up to reductions of 90% compared to observed mortality. Universal RV vaccination was not considered cost-effective (mean ICER: €60,200/QALY) unless herd-immunity and caretaker QALY losses were included and vaccine prices were €60 at most (mean ICER: €21,309/QALY). CONCLUSION We recommend targeted RV vaccination for high-risk infants in developed countries.
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Affiliation(s)
- Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - Marie-Josée J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - Mariet Felderhof
- Department of Pediatrics, Spaarne Hospital, Postbus 770, Hoofddorp 2130 AT, The Netherlands
| | - Nico G Hartwig
- Department of Pediatrics, Sint-Franciscus Hospital, Postbus 10900, Rotterdam 3004 BA, The Netherlands
| | - Marlies van Houten
- Department of Pediatrics, Spaarne Hospital, Postbus 770, Hoofddorp 2130 AT, The Netherlands
| | - Léon Winkel
- Department of Pediatrics, Kennemer Hospital, Postbus 417, Haarlem 2000 AK, The Netherlands
| | - Wouter J de Waal
- Department of Pediatrics, Diakonessen Hospital, Postbus 80250, Utrecht 3508 TG, The Netherlands
| | - Marc JM Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
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Aballéa S, Millier A, Quilici S, Caroll S, Petrou S, Toumi M. A critical literature review of health economic evaluations of rotavirus vaccination. Hum Vaccin Immunother 2013; 9:1272-88. [PMID: 23571226 DOI: 10.4161/hv.24253] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Two licensed vaccines are available to prevent RVGE in infants. A worldwide critical review of economic evaluations of these vaccines was conducted. The objective was to describe differences in methodologies, assumptions and inputs and determine the key factors driving differences in conclusions. 68 economic evaluations were reviewed. RV vaccination was found to be cost-effective in developing countries, while conclusions varied between studies in developed countries. Many studies found that vaccination was likely to be cost-effective under some scenarios, such as lower prices scenarios, inclusion of herd protection, and/or adoption of a societal perspective. Other reasons for variability included uncertainty around healthcare visits incidence and lack of consensus on quality of life (QoL) valuation for infants and caregivers. New evidence on the vaccination effectiveness in real-world, new ways of modeling herd protection and assessments of QoL in children could help more precisely define the conditions under which RV vaccination would be cost-effective in developed countries.
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Gunn L, Feeney SA, Cashman O, Collins PJ, Coyle PV, O'Shea H. Molecular characterization of group A rotavirus found in elderly patients in Ireland; predominance of G1P[8], continued presence of G9P[8], and emergence of G2P[4]. J Med Virol 2013; 84:2008-17. [PMID: 23080510 DOI: 10.1002/jmv.23416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rotavirus is a major cause of gastroenteritis in young children worldwide. There have been several recent reports concerning rotavirus isolation from adults, particularly in the elderly, presenting with gastroenteritis. In this study, the authors report on rotavirus outbreaks in five separate elderly care facilities between April, and June 2011 in Ireland. The following genotypes were detected; G1P[8] (n = 5/11), G2P[4] (n = 2/11), and G9P[8] (n = 2/11). Thus, similarities to previous reports were found in that G1P[8] predominated, G9P[8] was still detected but G2P[4] was detected for the first time in a geriatric population in Ireland. Here also described is the detection of Group 2 lineage IIC rotavirus in Ireland for the first time.
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Affiliation(s)
- L Gunn
- Department of Biological Sciences, Cork Institute of Technology, Rossa Ave, Bishopstown, Cork, Ireland
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31
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The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales. Vaccine 2012; 30:6766-76. [DOI: 10.1016/j.vaccine.2012.09.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 11/23/2022]
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