Cost-effectiveness of childhood rotavirus vaccination in Germany |
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Authors: | Pamela Aidelsburger,Kristin Grabein,Katharina Bö hm,Markus Dietl,Jü rgen Wasem,Judith Koch,Bernhard Ultsch,Felix Weidemann,Ole Wichmann |
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Affiliation: | 1. CAREM GmbH, Sauerlach, Germany;2. Institute for Healthcare Management, University of Duisburg-Essen, Essen, Germany;3. Immunization Unit, Robert Koch Institute, Berlin, Germany;4. Charité University Medicine, Berlin, Germany |
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Abstract: | BackgroundRotavirus (RV) causes a highly contagious gastroenteritis especially in children under five years of age. Since 2006 two RV-vaccines are available in Europe (Rotarix® and RotaTeq®). To support informed decision-making within the German Standing Committee on Vaccination (STIKO) the cost-effectiveness of these two vaccines was evaluated for the German healthcare setting.MethodsA Markov model was developed to evaluate the cost-effectiveness from the statutory health insurance (SHI) and from the societal perspective. RV-cases prevented, RV-associated hospitalizations avoided, and quality-adjusted life years (QALY) gained were considered as health outcomes. RV-incidences were calculated based on data from the national mandatory disease reporting system. RV-vaccine efficacy was determined as pooled estimates based on data from randomized controlled trials. Vaccine list prices and price catalogues were used for cost-assessment. Effects and costs were discounted with an annual discount rate of 3%.ResultsThe base-case analysis (SHI-perspective) resulted in an incremental cost-effectiveness and cost-utility ratio for Rotarix® of € 184 per RV-case prevented, € 2457 per RV-associated hospitalization avoided, and € 116,973 per QALY gained. For RotaTeq®, the results were € 234 per RV-case prevented, € 2622 per RV-associated hospitalization avoided, and € 142,732 per QALY gained. Variation of various parameters in sensitivity analyses showed effects on the ICERs without changing the overall trend of base-case results. When applying base-case results to the 2012 birthcohort in Germany with 80% vaccination coverage, an estimated 206,000–242,000 RV-cases and 18,000 RV-associated hospitalizations can be prevented in this birthcohort over five years for an incremental cost of 44.5–48.2 million €.ConclusionOur analyses demonstrate that routine RV-vaccination could prevent a substantial number of RV-cases and hospitalizations in the German healthcare system, but the saved treatment costs are counteracted by costs for vaccination. However, with vaccine prices reduced by ∼62–66%, RV-vaccination could even become a cost-saving preventive measure. |
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Keywords: | Rotavirus Vaccination Health economic evaluation Cost effectiveness Markov model Germany |
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