title: Cost-effectiveness of childhood rotavirus vaccination in Germany.
abstract: BACKGROUND
  Rotavirus (RV) causes a highly contagious gastroenteritis especially in children under five years of age. Since 2006 two RV-vaccines are available in Europe (Rotarix(®) and RotaTeq(®)). To support informed decision-making within the German Standing Committee on Vaccination (STIKO) the cost-effectiveness of these two vaccines was evaluated for the German healthcare setting.
  
  
  METHODS
  A Markov model was developed to evaluate the cost-effectiveness from the statutory health insurance (SHI) and from the societal perspective. RV-cases prevented, RV-associated hospitalizations avoided, and quality-adjusted life years (QALY) gained were considered as health outcomes. RV-incidences were calculated based on data from the national mandatory disease reporting system. RV-vaccine efficacy was determined as pooled estimates based on data from randomized controlled trials. Vaccine list prices and price catalogues were used for cost-assessment. Effects and costs were discounted with an annual discount rate of 3%.
  
  
  RESULTS
  The base-case analysis (SHI-perspective) resulted in an incremental cost-effectiveness and cost-utility ratio for Rotarix(®) of € 184 per RV-case prevented, € 2457 per RV-associated hospitalization avoided, and € 116,973 per QALY gained. For RotaTeq(®), the results were € 234 per RV-case prevented, € 2622 per RV-associated hospitalization avoided, and € 142,732 per QALY gained. Variation of various parameters in sensitivity analyses showed effects on the ICERs without changing the overall trend of base-case results. When applying base-case results to the 2012 birthcohort in Germany with 80% vaccination coverage, an estimated 206,000-242,000 RV-cases and 18,000 RV-associated hospitalizations can be prevented in this birthcohort over five years for an incremental cost of 44.5-48.2 million €.
  
  
  CONCLUSIONS
  Our analyses demonstrate that routine RV-vaccination could prevent a substantial number of RV-cases and hospitalizations in the German healthcare system, but the saved treatment costs are counteracted by costs for vaccination. However, with vaccine prices reduced by ∼62-66%, RV-vaccination could even become a cost-saving preventive measure.
authors.affiliation: CAREM GmbH, Sauerlach, Germany. Electronic address: p.aidelsburger@carem.de.
authors.forename: Pamela
authors.initials: P
authors.lastname: Aidelsburger
authors.affiliation: CAREM GmbH, Sauerlach, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Grabein
authors.affiliation: CAREM GmbH, Sauerlach, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Böhm
authors.affiliation: CAREM GmbH, Sauerlach, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dietl
authors.affiliation: Institute for Healthcare Management, University of Duisburg-Essen, Essen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.affiliation: Immunization Unit, Robert Koch Institute, Berlin, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Koch
authors.affiliation: Immunization Unit, Robert Koch Institute, Berlin, Germany; Charité University Medicine, Berlin, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ultsch
authors.affiliation: Immunization Unit, Robert Koch Institute, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Weidemann
authors.affiliation: Immunization Unit, Robert Koch Institute, Berlin, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005759:Gastroenteritis / Q000191:economics / Q000517:prevention & control* / Q000821:virology; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012400:Rotavirus Infections / Q000191:economics / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D014611:Vaccination / Q000191:economics*; D014613:Vaccines, Attenuated / Q000191:economics / Q000627:therapeutic use
chemical_list: C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: Cost effectiveness; Germany; Health economic evaluation; Markov model; Rotavirus; Vaccination