Cost-Effectiveness of Rotavirus Vaccination in Bolivia from the State Perspective

• Type of Material: Article
• Authors: Emily R. Smith, Emory University; Emily E. Rowlinson, Emory University; Volga Iniguez, Universidad Mayor de San Andrés; Kizee A. Etienne, Emory University; Rosario Rivera, Universidad Mayor de San Andrés; Nataniel Mamani, Universidad Mayor de San Andrés; Rick Rheingans, University of Florida; Maritza Patzi, Ministerio de Salud y Deportes de Bolivia; Percy Halkyer, PanAmerican Health Organization; Juan S. Leon, Emory University
• Language: English
• Date: 2011-09-02
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2011.05.038
• Title of Journal or Parent Work: Vaccine
• ISSN: 0264-410X
• Volume: 29
• Issue: 38
• Start Page: 6704
• End Page: 6711
• Grant/Funding Information: This work was supported in part by The Eugene J. Gangarosa Fund, the Anne E. and William A. Foege Global Health Fund, the O.C. Hubert Charitable Trust, the RSPH Student Initiative Fund, the – NIH Global Frameworks Grant (2007–2010), the Emory University Global Health Institute, the New Aid Fellowship, the Bolivia National Rotavirus Surveillance Program (BNRSP), and the Swedish Cooperation ASDI-UMSA. J.S.L. was supported in part by funds from the Emory University Global Health Institute, NIH-NIAID (1K01AI087724 - 01) and USDA-NIFA (2010-85212-20608) grants
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state’s policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. METHODS To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6,751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. RESULTS Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. DISCUSSION Our data will guide Bolivia’s funding allocation for RV as international subsidies change.