title: Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis.
abstract: BACKGROUND
  An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households.
  
  
  METHODS
  We use a methodology of 'extended cost-effectiveness analysis' (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations.
  
  
  RESULTS
  In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program.
  
  
  CONCLUSIONS
  Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought.
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, United States. Electronic address: verguet@uw.edu.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.forename: Shane
authors.initials: S
authors.lastname: Murphy
authors.forename: Benjamin
authors.initials: B
authors.lastname: Anderson
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Johansson
authors.forename: Roger
authors.initials: R
authors.lastname: Glass
authors.forename: Richard
authors.initials: R
authors.lastname: Rheingans
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005002:Ethiopia; D005260:Female; D006291:Health Policy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012400:Rotavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D016019:Survival Analysis; D014611:Vaccination / Q000191:economics* / Q000379:methods
chemical_list: D022243:Rotavirus Vaccines
keywords: Child health; Equity; Extended cost-effectiveness analysis (ECEA); Financial risk protection; Low- and middle-income settings; Rotavirus; Vaccination