Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis.
BACKGROUND
Rotavirus is the leading cause of acute severe diarrhea among children under 5 globally and one of the leading causes of death attributable to diarrhea. Among African children hospitalized with diarrhea, 38% of the cases are due to rotavirus. In Senegal, rotavirus deaths are estimated to represent 5.4% of all deaths among children under 5. Along with the substantial disease burden, there is a growing awareness of the economic burden created by diarrheal disease. This analysis aims to provide policymakers with more consistent and reliable economic evidence to support the decision-making process about the introduction and maintenance of a rotavirus vaccine program.


METHODS
The study was conducted using the processes and tools first established by the Pan American Health Organization's ProVac Initiative in the Latin American region. TRIVAC version 2.0, an Excel-based model, was used to perform the analysis. The costs and health outcomes were calculated for 20 successive birth cohorts (2014-2033). Model inputs were gathered from local, national, and international sources with the guidance of a Senegalese group of experts including local pediatricians, personnel from the Ministry of Health and the World Health Organization, as well as disease-surveillance and laboratory specialists.


RESULTS
The cost per disability-adjusted life-year (DALY) averted, discounted at 3%, is US$ 92 from the health care provider perspective and US$ 73 from the societal perspective. For the 20 cohorts, the vaccine is projected to prevent more than 2 million cases of rotavirus and to avert more than 8500 deaths. The proportion of rotavirus deaths averted is estimated to be 42%. For 20 cohorts, the discounted net costs of the program were estimated to be US$ 17.6 million from the healthcare provider perspective and US$ 13.8 million from the societal perspective.


CONCLUSIONS
From both perspectives, introducing the rotavirus vaccine is highly cost-effective compared to no vaccination. The results are consistent with those found in many African countries. The ProVac process and tools contributed to a collaborative, country-led process in Senegal that provides a platform for gathering and reporting evidence for vaccine decision-making.
Independent Consultant for PATH, Dakar, Senegal.
Abdou
A
Diop
PATH, Seattle, WA, United States. Electronic address: datherly@path.org.
Deborah
D
Atherly
Fatick Hospital, Fatick, Senegal.
Alioune
A
Faye
WHO, Dakar, Senegal.
Farba
F
Lamine Sall
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Andrew D
AD
Clark
Principal Hospital, Dakar, Senegal.
Leon
L
Nadiel
Ministry of Health, Dakar, Senegal.
Binetou
B
Yade
Ministry of Health, Dakar, Senegal.
Mamadou
M
Ndiaye
Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal.
Moussa
M
Fafa Cissé
Albert Royer Children's Hospital, University Cheikh Anta Diop, Dakar, Senegal.
Mamadou
M
Ba
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; 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*; D012675:Senegal / Q000453:epidemiology; D014611:Vaccination / Q000191:economics* / Q000379:methods
D022243:Rotavirus Vaccines
Cost-effectiveness; DALY; Rotavirus; Senegal; Vaccination