title: Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi.
abstract: OBJECTIVE
  Worldwide, rotavirus infections cause approximately 453,000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost.
  
  
  METHODS
  Following the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis.
  
  
  RESULTS
  The total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components.
  
  
  CONCLUSIONS
  The total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing.
authors: Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Lizell B
authors: LB
authors: Madsen
authors: Marte
authors: M
authors: Ustrup
authors: Kristian S
authors: KS
authors: Hansen
authors: Peter S
authors: PS
authors: Nyasulu
authors: Ib C
authors: IC
authors: Bygbjerg
authors: Flemming
authors: F
authors: Konradsen
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D008295:Malawi; D012401:Rotavirus / Q000276:immunology; D012400:Rotavirus Infections / Q000191:economics* / Q000276:immunology / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000191:economics* / Q000276:immunology; D014611:Vaccination / Q000191:economics*; D014944:World Health Organization
chemical_list: D022243:Rotavirus Vaccines
keywords: Malawi; cost analysis; costs; developing countries; immunisation programmes; rotavirus vaccines