title: Cost-effectiveness of rotavirus vaccination in Bolivia from the state perspective.
abstract: BACKGROUND
  In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program.
  
  
  METHODS
  To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia.
  
  
  RESULTS
  Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness.
  
  
  CONCLUSIONS
  Our data will guide Bolivia's funding allocation for RV as international subsidies change.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, United States.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Smith
authors.forename: Emily E
authors.initials: EE
authors.lastname: Rowlinson
authors.forename: Volga
authors.initials: V
authors.lastname: Iniguez
authors.forename: Kizee A
authors.initials: KA
authors.lastname: Etienne
authors.forename: Rosario
authors.initials: R
authors.lastname: Rivera
authors.forename: Nataniel
authors.initials: N
authors.lastname: Mamani
authors.forename: Rick
authors.initials: R
authors.lastname: Rheingans
authors.forename: Maritza
authors.initials: M
authors.lastname: Patzi
authors.forename: Percy
authors.initials: P
authors.lastname: Halkyer
authors.forename: Juan S
authors.initials: JS
authors.lastname: Leon
mesh_terms: D001838:Bolivia / Q000453:epidemiology; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012400:Rotavirus Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000191:economics*; D014611:Vaccination / Q000191:economics*
chemical_list: D022243:Rotavirus Vaccines