title: Estimated impact and cost-effectiveness of rotavirus vaccination in India: effects of geographic and economic disparities.
abstract: India accounts for 23% of global rotavirus mortality in under-five children, with more than 100,000 deaths from rotavirus annually. Introduction of a vaccine in India is considered to be the most effective intervention for preventing rotavirus mortality. Recent research suggests that there is considerable variation in rotavirus mortality burden across regional, gender and socio-economic subpopulations within India. In addition, there is potential variability in who would likely receive rotavirus vaccine if introduced. We use available household data to estimate heterogeneity in rotavirus mortality risk, vaccination benefits, and cost-effectiveness across geographic and socio-economic groups within India. We account for heterogeneity by modeling estimated three-dose routine vaccinations as a proxy for a generalized rotavirus vaccine, and mortality for subpopulations of children aggregated by region and state, socio-economic status and sex, separately. Results are presented for six geographic regions and for Bihar, Uttar Pradesh, and Madhya Pradesh, three high mortality states accounting for 56% of national mortality estimates. Impact estimates accounting for disparities predict rotavirus vaccine introduction will prevent 35,000 deaths at an average cost of $118/DALY averted (7292 INR/DALY averted). Rotavirus vaccines are most cost-effective for the poor living in high mortality regions and states. Reductions in geographic and socio-economic disparities based on regional estimates could prevent an additional 9400 deaths annually, while reductions in socio-economic disparities in the three highest morality states alone could prevent an additional 10,600 deaths annually. Understanding the impact of heterogeneity can help improve strategies to maximize the benefits of rotavirus vaccination introduction, leading to fewer lives lost as a result of rotavirus disease.
authors.affiliation: Department of Environmental and Global Health, Center for African Studies, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: rrheing@epi.ufl.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Rheingans
authors.affiliation: Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: j5anders@epi.ufl.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Anderson
authors.affiliation: Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: ander88@epi.ufl.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Department of Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: poulomyc@epi.ufl.edu.
authors.forename: Poulomy
authors.initials: P
authors.lastname: Chakraborty
authors.affiliation: PATH, Seattle, WA, USA. Electronic address: datherly@path.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Atherly
authors.affiliation: Department of Geography and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA. Electronic address: dpindolia@gmail.com.
authors.forename: Deepa
authors.initials: D
authors.lastname: Pindolia
mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005843:Geography; D017048:Health Care Costs; D054624:Health Status Disparities; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D018803:Models, Economic; D012400:Rotavirus Infections / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics*; D012959:Socioeconomic Factors; D014611:Vaccination / Q000191:economics*
chemical_list: D022243:Rotavirus Vaccines
keywords: Cost-effectiveness; Disparities; Equity; India; Rotavirus; Vaccination