title: Costs of diarrheal disease and the cost-effectiveness of a rotavirus vaccination program in kyrgyzstan.
abstract: BACKGROUND
  We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance.
  
  
  METHODS
  We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses.
  
  
  RESULTS
  Rotavirus-related hospitalizations and outpatient visits cost US$580,864 annually, of which $421,658 (73%) is direct medical costs and $159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert $386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is $0.65/dose; the societal break-even price is $1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of $0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price $9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report.
  
  
  CONCLUSIONS
  Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price $9.41 per dose.
authors.affiliation: Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. elmira.flem@fhi.no
authors.forename: Elmira T
authors.initials: ET
authors.lastname: Flem
authors.forename: Renat
authors.initials: R
authors.lastname: Latipov
authors.forename: Zuridin S
authors.initials: ZS
authors.lastname: Nurmatov
authors.forename: Yiting
authors.initials: Y
authors.lastname: Xue
authors.forename: Kaliya T
authors.initials: KT
authors.lastname: Kasymbekova
authors.forename: Richard D
authors.initials: RD
authors.lastname: Rheingans
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000191:economics* / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D007223:Infant; D007231:Infant, Newborn; D007707:Kyrgyzstan; D012400:Rotavirus Infections / Q000191:economics* / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000191:economics* / Q000276:immunology; D014611:Vaccination / Q000191:economics*
chemical_list: D022243:Rotavirus Vaccines