Cost-effectiveness of rotavirus vaccination in Kenya and Uganda.
BACKGROUND
Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda.


METHODS
In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda.


RESULTS
Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective).


CONCLUSIONS
Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national capacity to undertake economic evaluations.
P.O. Box 293-20203, Londiani, Kenya.
Charles
C
Sigei
Uganda Martyrs University, Nkozi, P.O., Box 5498, Kampala, Uganda; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
John
J
Odaga
PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA. Electronic address: mmvundura@path.org.
Mercy
M
Mvundura
PATH, Route de Ferney 207, 1218 Le Grand Saconnex, Geneva, Switzerland.
Yvette
Y
Madrid
Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Andrew David
AD
Clark
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005759:Gastroenteritis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / 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*; D014454:Uganda / Q000453:epidemiology; D014611:Vaccination / Q000191:economics* / Q000379:methods
D022243:Rotavirus Vaccines
Cost-effectiveness analysis; DALYs; Kenya; Rotavirus; TRIVAC; Uganda; Vaccination