Cost-effectiveness of rotavirus vaccination in Albania.
BACKGROUND
Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines.


METHODS
The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs).


RESULTS
With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively.


CONCLUSIONS
From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases and deaths were based on plausible minimum estimates. Introduction of RV1 would yield similar benefits at lower cost.
Institute of Public Health, Tirana, Albania. Electronic address: albiahmeti@yahoo.com.
Albana
A
Ahmeti
Institute of Public Health, Tirana, Albania.
Iria
I
Preza
Institute of Public Health, Tirana, Albania.
Artan
A
Simaku
Institute of Public Health, Tirana, Albania.
Erida
E
Nelaj
London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Andrew David
AD
Clark
Pan American Health Organization (WHO/PAHO), Washington, DC, USA.
Ana Gabriela
AG
Felix Garcia
Agence de Médecine Préventive (AMP), Paris, France.
Carlos
C
Lara
Agence de Médecine Préventive (AMP), Paris, France.
Céline
C
Hoestlandt
Agence de Médecine Préventive (AMP), Paris, France.
Julia
J
Blau
Institute of Public Health, Tirana, Albania.
Silvia
S
Bino
D000415:Albania / Q000453:epidemiology; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D012400:Rotavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D014611:Vaccination / Q000191:economics* / Q000379:methods
D022243:Rotavirus Vaccines
Albania; Cost-effectiveness; Diarrhea; Evidenced-based medicine; Rotavirus; Vaccine