Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.
BACKGROUND
Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society.


METHODS
The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results.


RESULTS
Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario.


CONCLUSIONS
Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address: m.javanbakht@abdn.ac.uk.
Mehdi
M
Javanbakht
Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mmoradi@uw.edu.
Maziar
M
Moradi-Lakeh
Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. Electronic address: mohsenyaq@yahoo.com.
Mohsen
M
Yaghoubi
Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran. Electronic address: Esteghamati@gmail.com.
Abdoulreza
A
Esteghamati
Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: roxanaghanaie@yahoo.com.
Roxana
R
Mansour Ghanaie
Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. Electronic address: Sussanmahmoody@yahoo.com.
Sussan
S
Mahmoudi
Tehran University of Medical Sciences, Tehran, Iran. Electronic address: ar_shamshiri@yahoo.com.
Ahmad-Reza
AR
Shamshiri
Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. Electronic address: zahraeicdc@yahoo.com.
Seyed Mohsen
SM
Zahraei
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: Louise.Baxter@lshtm.ac.uk.
Louise
L
Baxter
School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: sarehshakareian@gmail.com.
Sareh
S
Shakerian
Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt. Electronic address: CHAUDHRII@emro.who.int.
Irtaza
I
Chaudhri
PATH, Seattle, WA, USA. Electronic address: jfleming@path.org.
Jessica A
JA
Fleming
Agence de Médecine Préventive, Paris, France. Electronic address: amunier@aamp.org.
Aline
A
Munier
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran. Electronic address: baradaran.hr@iums.ac.ir.
Hamid R
HR
Baradaran
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; D007492:Iran / Q000453:epidemiology; 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; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000191:economics / Q000276:immunology
C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
Cost-effectiveness; DALY; Iran; Rotavirus diarrhea; TRIVAC model; Vaccine