Cost-effectiveness analysis of rotavirus vaccination in Argentina.
BACKGROUND
Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule.


METHODS
The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios.


RESULTS
The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate.


CONCLUSIONS
Compared to no vaccination, routine vaccination against rotavirus in Argentina would be highly cost-effective with either vaccine. Health and economic benefits would be higher in the Northeast and Northwest regions, where the intervention would even be cost-saving.
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: uruenaanalia@gmail.com.
Analía
A
Urueña
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: tpippo@msal.gov.ar.
Tomás
T
Pippo
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: solbetelu@hotmail.com.
María Sol
MS
Betelu
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: federicomv82@hotmail.com.
Federico
F
Virgilio
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina.
Laura
L
Hernández
Hospital de Niños "Dr. Ricardo Gutiérrez," Gallo 1330 (1425), Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: norbergiglio@gmail.com.
Norberto
N
Giglio
Sociedad Argentina de Pediatría, Av. Coronel Díaz 1971/75 (C1425DQF), Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: angelagentile@fibertel.com.ar.
Ángela
Á
Gentile
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: mdiosque@msal.gov.ar.
Máximo
M
Diosque
Ministerio de Salud de la Nación, Av. 9 de Julio 1925 (C1073ABA) , Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: cvizzotti@yahoo.com.ar.
Carla
C
Vizzotti
D001118:Argentina / Q000453:epidemiology; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology / Q000401:mortality / 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 / Q000401:mortality / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D014611:Vaccination / Q000191:economics* / Q000379:methods; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000191:economics / Q000276:immunology
C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
Argentina; Cost-effectiveness; Rotavirus vaccination