Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia |
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| Affiliation: | 1. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia;2. Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium;3. Discipline of Child and Adolescent Health, University of Sydney, NSW, Australia;4. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children’s Hospital at Westmead, NSW, Australia;5. Discipline of Child and Adolescent Health and School of Public Health, University of Sydney, NSW, Australia;1. Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States;2. Department of Neurological Surgery, University of Iowa, Department of Neurosurgery, Iowa City, IA, United States;3. Department of Neurological Surgery, Arkansas Neurosciences Institute, Little Rock, AR, United States;1. Department of Biology, McGill University, Stewart Biology Building, 1205 ave Docteur Penfield, Montreal, QC, Canada H3A 1B1;2. School of Environment, McGill University, 3534 University St., Montreal, QC, Canada H3A 2A7;1. University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States;2. University of Washington, Department of Epidemiology, 3980 15th Ave NE, Seattle, WA 98195, United States;3. University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States;4. University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States;1. Department of Infectious Disease, Children’s Hospital of Fudan University, National Children''s Medical Center, Shanghai, China;2. Department of Microbiology, Changning District Center for Disease Control and Prevention, Shanghai, China;3. Department of Clinical Laboratory, Children''s Hospital of Fudan University, National Children''s Medical Center, Shanghai, China;4. Institute of Immunization, Shanghai Municipal Center of Disease Control and Prevention, Shanghai, China;5. Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China;1. Department of Preventive Medicine & Public Health, Medical Immunology and Microbiology, Rey Juan Carlos University, Madrid, Spain;2. Medical and Scientific Department, Sanofi Pasteur, Madrid, Spain;1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia;2. Centre de recherche du CHU de Québec—Université Laval, Québec, Canada;3. Département de médecine sociale et préventive, Université Laval, Québec, Canada;4. Department of Infectious Disease Epidemiology, Imperial College, London, UK;5. School of Public Health, Sydney Medical School, University of Sydney, NSW, Australia;6. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia |
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| Abstract: | BackgroundUniversal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction.MethodsWe conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations.ResultsRelative to the baseline period (1997–2006), over the 6 years (2007–2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5 years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program.ConclusionThe inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted by pre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs. |
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| Keywords: | Cost-effectiveness Economic evaluation Retrospective Post-implementation Vaccination Rotavirus |
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