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. 2010 Sep 1;202 Suppl(Suppl 1):S108-15.
doi: 10.1086/653578.

The cost-effectiveness of rotavirus vaccination in Malawi

Stephen A Berry  1 , Benjamin Johns, Chuck Shih, Andrea A Berry, Damian G Walker
Affiliations

The cost-effectiveness of rotavirus vaccination in Malawi

Stephen A Berry et al. J Infect Dis. .

Abstract

Background: Rotarix (GlaxoSmithKline), a newly licensed rotavirus vaccine requiring 2 doses, may have the potential to save hundreds of thousands of lives in Africa. Nations such as Malawi, where Rotarix is currently under phase III investigation, may nevertheless face difficult economic choices in considering vaccine adoption.

Methods: The cost-effectiveness of implementing a Rotarix vaccine program in Malawi was estimated using published estimates of rotavirus burden, vaccine efficacy, and health care utilization and costs.

Results: With 49.5% vaccine efficacy, a Rotarix program could avert 2582 deaths annually. With GAVI Alliance cofinancing, adoption of Rotarix would be associated with a cost of $5.07 per disability-adjusted life-year averted. With market pricing, Rotarix would be associated with a base case cost of $74.73 per disability-adjusted life-year averted. Key variables influencing results were vaccine efficacy, under-2 rotavirus mortality, and program cost of administering each dose.

Conclusions: Adopting Rotarix would likely be highly cost-effective for Malawi, particularly with GAVI support. This finding holds true across uncertainty ranges for key variables, including efficacy, for which data are becoming available.

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Conflict of interest statement

Potential conflicts of interest: none reported.

Figures

Figure 1.
Figure 1.
Decision analysis tree for a rotavirus vaccination program.
Figure 2.
Figure 2.
Tornado diagrams of 1-way sensitivity analyses. End points of each bar represent incremental cost-effectiveness ratios at the low and high ends of the range for each parameter shown to the right. The base case incremental cost-effectiveness ratio is indicated.
Figure 3.
Figure 3.
Two-way sensitivity analysis of the Rotarix program incremental cost-effectiveness ratio (ICER) on vaccine efficacy and market price per dose. The ICER estimates are determined under the assumption that under-2 rotavirus-associated mortality is at its lowest potential value of 0.0084. Combinations of price and efficacy highlighted in the hatched area would result in an ICER <$312 per disability-adjusted life-year averted.
Table 1.
Table 1.
Epidemiologic, Clinical, and Economic Variable Estimates
Table 2.
Table 2.
Costs and Outcomes from a Rotarix Vaccination Program under GAVI Alliance and Market Vaccine Pricing
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