title: Comparing cost-effectiveness results for a vaccine across different countries worldwide: what can we learn?
abstract: BACKGROUND
  Cost-effectiveness analysis (CEA) using country-specific thresholds tied to gross domestic product (GDP) might not be appropriate in countries with low healthcare investment and a high disease burden as a consequence.
  
  
  METHODS
  Using data from previously published CEA of rotavirus vaccination across nine countries worldwide, we calculated the cost neutral price (Pn) for the new intervention that reflects the price resulting in no net increase in health care costs compared with the current situation, and the maximum price (Pm) obtained with an incremental cost-effectiveness ratio (ICER) at the threshold value of 1×GDP/capita.
  
  
  RESULTS
  In countries with low GDP/capita, the paradoxical finding for rotavirus vaccination is that the Pm is much higher than in countries with a high GDP/capita. On the other hand, the Pn for the low GDP/capita countries is much lower than for high GDP/capita countries because of the low investment in health care.
  
  
  CONCLUSIONS
  In countries with low healthcare investment and a high disease burden, the difference between the Pn and Pm for rotavirus vaccine which is the price range within which the ICER is below the World Health Organization (WHO) threshold value, is large. One reason could be that the WHO threshold value may not properly account for the local opportunity cost of health care expenditures. Therefore, either alternative threshold values should be selected or alternative economic assessment tools should be considered, such as budget optimisation or return on investment, if we want to communicate about real economic value of new vaccines in those countries.
authors.affiliation: Health Economics Department, GSK Vaccines, Wavre, Belgium, baudouin.a.standaert@gsk.com.
authors.forename: Baudouin
authors.initials: B
authors.lastname: Standaert
authors.forename: Olivier
authors.initials: O
authors.lastname: Ethgen
authors.forename: Rachel
authors.initials: R
authors.lastname: Emerson
authors.forename: Maarten
authors.initials: M
authors.lastname: Postma
authors.forename: Josephine
authors.initials: J
authors.lastname: Mauskopf
mesh_terms: D003362:Cost-Benefit Analysis; D014943:Global Health / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008962:Models, Theoretical; D012040:Regional Health Planning / Q000191:economics / Q000379:methods; D012400:Rotavirus Infections / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics / Q000627:therapeutic use; D014611:Vaccination / Q000191:economics / Q000379:methods
chemical_list: D022243:Rotavirus Vaccines