title: Rotavirus vaccination: cost-effectiveness and impact on child mortality in developing countries.
abstract: BACKGROUND
  Rotavirus is the leading cause of severe gastroenteritis in children <5 years of age and is responsible for >500,000 deaths annually; approximately 85% of this burden is in low-income countries eligible for financial support from the GAVI Alliance. We projected the uptake, health impact, and cost-effectiveness of introducing rotavirus vaccination in GAVI-eligible countries to help policy makers in prioritizing resources to gain the greatest health improvements for their constituencies.
  
  
  METHODS
  A demand forecast model was used to predict adoption of rotavirus vaccine in the poorest countries in the world. We then modeled health outcomes and direct costs of a hypothetical birth cohort in the target population for scenarios with and without a rotavirus vaccine with use of data on health outcomes of rotavirus infection, vaccine effectiveness, and immunization rates.
  
  
  RESULTS
  Vaccination would prevent 2.4 million rotavirus deaths and >82 million disability-adjusted life-years (DALYs) in 64 of the 72 GAVI-eligible countries introducing vaccine from 2007 through 2025. The cost per DALY averted decreases over time, from a high of US$450 per DALY averted in the first year to a sustained low of $30 per DALY during 2017-2025, with a cumulative figure of $43 per DALY averted during 2008-2025. By applying the baseline scenario with an initial vaccine price of $7 per dose for a 2-dose vaccine, with a gradual decrease beginning in 2012 and stabilizing at $1.25 per dose by 2017, vaccination was very cost-effective in all GAVI-eligible countries with use of each country's gross domestic product per DALY averted as a threshold.
  
  
  CONCLUSIONS
  Introduction of rotavirus vaccines into the world's poorest countries is very cost-effective and is projected to substantially reduce childhood mortality.
authors.affiliation: PATH, Seattle, Washington 98107, USA. datherly@path.org
authors.forename: Deborah
authors.initials: D
authors.lastname: Atherly
authors.forename: Robert
authors.initials: R
authors.lastname: Dreibelbis
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Carol
authors.initials: C
authors.lastname: Levin
authors.forename: John
authors.initials: J
authors.lastname: Wecker
authors.forename: Richard D
authors.initials: RD
authors.lastname: Rheingans
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006801:Humans; D012400:Rotavirus Infections / Q000401:mortality*; D022243:Rotavirus Vaccines / Q000191:economics / Q000276:immunology*; D013997:Time Factors; D014611:Vaccination / Q000191:economics
chemical_list: D022243:Rotavirus Vaccines