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. 2022 Aug 26;40(36):5338-5346.
doi: 10.1016/j.vaccine.2022.07.044. Epub 2022 Aug 3.

Cost-effectiveness of rotavirus vaccination in Mozambique

Esperança Lourenço Guimarães  1 , Assucênio Chissaque  2 , Clint Pecenka  3 , Andrew Clark  4 , Basília Vaz  5 , Arlindo Banze  6 , Neide Canana  5 , Clésio Romão  6 , Maria do Rosário Oliveira Martins  7 , Nilsa de Deus  8 , Frédéric Debellut  9
Affiliations

Cost-effectiveness of rotavirus vaccination in Mozambique

Esperança Lourenço Guimarães et al. Vaccine. .

Abstract

Introduction: Rotavirus is one of the most common cause of severe gastroenteritis in children, with the largest mortality burden in low- and middle-income countries. To prevent rotavirus gastroenteritis, Mozambique introduced ROTARIX® vaccine in 2015, however, its cost-effectiveness has never been established in the country. In 2018, additional vaccines became available globally. This study estimates the cost-effectiveness of the recently introduced ROTARIX in Mozambique and compares the cost-effectiveness of ROTARIX®, ROTAVAC®, and ROTASIIL® to inform future use.

Methods: We used a decision-support model to calculate the potential cost-effectiveness of vaccination with ROTARIX compared to no vaccination over a five-year period (2016-2020) and to compare the cost-effectiveness of ROTARIX, ROTAVAC, and ROTASIIL to no vaccination and to each other over a ten-year period (2021-2030). The primary outcome was the incremental cost per disability-adjusted life-year (DALY) averted from a government perspective. We assessed uncertainty through sensitivity analyses.

Results: From 2016 to 2020, we estimate the vaccine program with ROTARIX cost US$12.3 million, prevented 4,628 deaths, and averted US$3.1 million in healthcare costs. The cost per DALY averted was US$70. From 2021 to 2030, we estimate all three vaccines could prevent 9,000 deaths and avert US$7.8 million in healthcare costs. With Global Alliance for Vaccines and Immunization (Gavi) support, ROTARIX would have the lowest vaccine program cost (US$31 million) and 98 % probability of being cost-effective at a willingness-to-pay threshold of 0.5x GDP per capita. Without Gavi support, ROTASIIL would have the lowest vaccine program cost (US$75.8 million) and 30 % probability of being cost-effective at the same threshold.

Conclusion: ROTARIX vaccination had a substantial public health impact in Mozambique between 2016 and 2020. ROTARIX is currently estimated to be the most cost-effective product, but the choice of vaccine should be re-evaluated as more evidence emerges on the price, incremental delivery cost, wastage, and impact associated with each of the different rotavirus vaccines.

Keywords: Cost-effectiveness; Diarrhea; Modelling; Mozambique; Rotavirus; UNIVAC; Vaccination.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Scenario analysis results, showing incremental cost-effectiveness ratio (US$ per DALY averted) of ROTARIX, compared to no vaccination.
Fig. 2
Fig. 2
Cost-effectiveness plane showing the incremental costs and benefits of vaccination with ROTARIX, ROTAVAC, and ROTASIIL, compared to no vaccination.
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve for the probabilistic sensitivity analysis of ROTARIX (with Gavi support) and ROTASIIL (without Gavi support) over the period 2021–2030.
See this image and copyright information in PMC

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