title: Cost-effectiveness of childhood rotavirus vaccination in Taiwan.
abstract: OBJECTIVE
  Rotavirus is the most common cause of severe diarrhea in children. Two rotavirus vaccines (RotaTeq and Rotarix) have been licensed in Taiwan. We have investigated whether routine infant immunization with either vaccine could be cost-effective in Taiwan.
  
  
  METHODS
  We modeled specific disease outcomes including hospitalization, emergency department visits, hospital outpatient visits, physician office visits, and death. Cost-effectiveness was analyzed from the perspectives of the health care system and society. A decision tree was used to estimate the disease burden and costs based on data from published and unpublished sources.
  
  
  RESULTS
  A routine rotavirus immunization program would prevent 146,470 (Rotarix) or 149,937 (RotaTeq) cases of rotavirus diarrhea per year, and would prevent 21,106 (Rotarix) and 23,057 (RotaTeq) serious cases (hospitalizations, emergency department visits, and death). At US$80 per dose for the Rotarix vaccine, the program would cost US$32.7 million, provided an increasing cost offset of US$19.8 million to the health care system with $135 per case averted. Threshold analysis identified a break-even price per dose of US$27 from the health care system perspective and US$41 from a societal perspective. At US$60.0 per dose of RotaTeq vaccine, the program would cost US$35.4 million and provide an increasing cost offset of US$22.5 million to the health care system, or US$150 per case averted. Threshold analysis identified a break-even price per dose of US$20.0 from the health care system perspective and $29 from the societal perspective. Greater costs of hospitalization and lower vaccine price could increase cost-effectiveness.
  
  
  CONCLUSIONS
  Despite a higher burden of serious rotavirus disease than estimated previously, routine rotavirus vaccination would unlikely be cost-saving in Taiwan at present unless the price fell to US$41 (Rotarix) or US$29 (RotaTeq) per dose from societal perspective, respectively. Nonetheless, rotavirus immunization could reduce the substantial burden of short-term morbidity due to rotavirus.
authors.affiliation: Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Wu
authors.forename: Yi-Ching
authors.initials: YC
authors.lastname: Yang
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
authors.forename: Kow-Tong
authors.initials: KT
authors.lastname: Chen
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005759:Gastroenteritis / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007223:Infant; D012400:Rotavirus Infections / Q000191:economics / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000191:economics*; D013624:Taiwan; D014613:Vaccines, Attenuated / Q000191:economics*
chemical_list: C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated