Cost-effectiveness of rotavirus vaccination in peru.
BACKGROUND
There are plans to introduce the oral rotavirus vaccine Rotarix (GlaxoSmithKline), 1 of 2 recently developed vaccines against rotavirus, in Peru.


METHODS
We modeled the cost-effectiveness of adding a rotavirus vaccine to the Peruvian immunization program under 3 scenarios for the timing of vaccination: (1) strictly according to schedule, at 2 and 4 months of age (on time); (2) distributed around the target ages in the same way as the actual timings in the program (flexible); and (3) flexible but assuming vaccination is not initiated for infants >12 weeks of age (restricted). We assumed an introductory price of US $7.50 per dose, and varied the annual rate of price decrease in sensitivity analyses.


RESULTS
The discounted cost per disability-adjusted life-year averted for restricted, flexible, and on-time schedules was $621, $615, and $581, respectively. For each of the 3 scenarios, the percentage reduction in deaths due to rotavirus infection was 53%, 66%, and 69%, respectively. The cost per disability-adjusted life-year averted for alternative "what-if" scenarios ranged from $229 (assuming a 1-dose schedule, administered on time) to $1491 (assuming a 2-dose schedule, with half the baseline vaccine efficacy rates and a restricted timing policy).


CONCLUSIONS
On the basis of current World Health Organization guidelines, rotavirus vaccination represents a highly cost-effective intervention in Peru. Withholding the vaccine from children who present for their first dose after 12 weeks of age would reduce the number of deaths averted by approximately 20%. A single dose may be more cost-effective than 2 doses, but more evidence on the protection conferred by a single dose is required.
Clark
Andrew D
AD
London School of Hygiene and Tropical Medicine, London, United Kingdom. andrew.clark@lshtm.ac.uk
Walker
Damian G
DG
Mosqueira
N Rocio
NR
Penny
Mary E
ME
Lanata
Claudio F
CF
Fox-Rushby
Julia
J
Sanderson
Colin F B
CF
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007223:Infant; D010568:Peru; D012400:Rotavirus Infections / Q000401:mortality; D022243:Rotavirus Vaccines / Q000191:economics*; D014611:Vaccination / Q000191:economics*
D022243:Rotavirus Vaccines