Potential Clinical and Economic Value of Norovirus Vaccination in the Community Setting

Abstract

Introduction: With norovirus vaccine candidates currently under development, now is the time to identify the vaccine characteristics and implementation thresholds at which vaccination becomes cost effective and cost saving in a community setting.

Methods: In 2020, a norovirus transmission, clinical, and economics computational simulation model representing different U.S. population segments was developed to simulate the spread of norovirus and the potential impact of vaccinating children aged <5 years and older adults (aged ≥65 years).

Results: Compared with no vaccination, vaccinating preschool-aged children averted 8%-72% of symptomatic norovirus cases in a community, whereas vaccinating older adults averted 2%-29% of symptomatic cases (varying with vaccine efficacy [25%-75%] and vaccination coverage [10%-80%]). Vaccination with a 25% vaccine efficacy was cost effective (incremental cost-effectiveness ratio ≤$50,000 per quality-adjusted life year) when vaccination cost ≤$445 and cost saving at ≤$370 when vaccinating preschool-aged children and ≤$42 and ≤$30, respectively, when vaccinating older adults. With a 50% vaccine efficacy, vaccination was cost effective when it cost ≤$1,190 and cost saving at ≤$930 when vaccinating preschool-aged children and ≤$110 and ≤$64, respectively, when vaccinating older adults. These cost thresholds (cost effective and cost saving, respectively) further increased with a 75% vaccine efficacy to ≤$1,600 and ≤$1,300 for preschool-aged children and ≤$165 and ≤$100 for older adults.

Conclusions: This study outlines thresholds at which a norovirus vaccine would be cost effective and cost saving in the community when vaccinating children aged <5 years and older adults. Establishing these thresholds can help provide decision makers with targets to consider when developing and implementing a norovirus vaccine.

Figure 1.

Vaccination cost and vaccination coverage at which norovirus vaccination was cost effective^a compared with no vaccination across different vaccine efficacies from the societal perspective in a population of 2,500 persons when targeting (A) preschool-aged children (aged 0–4 years); (B) older adults (aged ≥65 years); and (C) preschool-aged children and older adults. Notes: Note difference in scales across panels. ^aIncremental cost–effectiveness ratio ≤$50,000 and ≤$100,000 per QALY. QALY, quality-adjusted life year.

Figure 2.

Vaccination cost and vaccination coverage at which norovirus vaccination was cost effective^a compared with no vaccination across different vaccine efficacies from the third-party payer perspective in a population of 2,500 persons when targeting (A) preschool-aged children (aged 0–4 years); (B) older adults (aged ≥65 years); and (C) preschool-aged children and older adults. Notes: Note difference in scales across panels. ^aIncremental cost–effectiveness ratio ≤$50,000 and ≤$100,000 per QALY. QALY, quality-adjusted life year.