Do current cost-effectiveness analyses reflect the full value of childhood vaccination in Europe? A rotavirus case study

Abstract

Economic evaluation of vaccination programs can be challenging and does not always fully capture the benefits provided. Reasons for this include the difficulties incurred in accurately capturing the health and economic impact of infectious diseases and how different diseases may interact with each other. Rotavirus infection, for example, peaks at a similar time than other infectious diseases, such as RSV and influenza, which can cause hospital overcrowding and disruption, and may pose a risk to more vulnerable children due to limited availability of isolation facilities. Another challenge, specific to evaluating childhood vaccination, is that QoL cannot be accurately measured in children due to a lack of validated instruments. Childhood diseases also incur a care giver burden, due to the need for parents to take time off work, and this is important to consider. Finally, for diseases such as RVGE, cost-effectiveness analyses in which longer time horizons are considered may not reflect the short-term benefits of vaccination. Further quantification of the economic impact of childhood diseases is thus required to fully highlight the true benefits of childhood vaccination that may be realized. Herein we explore the limitations of existing economic evaluations for childhood vaccination, and how economic analyses could be better adapted in future.

Keywords: benefits; cost-effectiveness; economic evaluation; pediatric; rotavirus; seasonality; vaccination.

Figure 1. Budget impact analysis showing the cumulative mean annual percentage payback predicted for introduction of RV vaccination in England and Wales. The 2 graphs show different vaccine waning and cost scenarios: (A) immediate vaccine immunity waning after vaccination, concomitant vaccine administration; (B) delayed vaccine immunity waning after vaccination, concomitant vaccine administration. The black line is the median, and the gray area represents the 95% predictive range. Price for a full-course regimen is taken to be £60. Discount rate is fixed at 3.5%. SOURCE: 18; Reprinted from Vaccine, Vol 30, Atkins K E, Shim E, Carroll S, Quilici, S, Galvani, A P, The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales, Pages 6766–6776, Copyright (2012), with permission from Elsevier.

Figure 2. Limitations of current economic evaluations of the RV vaccine, and how these might be addressed in the future.