title: Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania.
abstract: BACKGROUND
  Globally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).
  
  
  METHODS
  We quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon.
  
  
  RESULTS
  The average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80-218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).
  
  
  CONCLUSIONS
  The combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.
authors.affiliation: School of Public Health and Social Sciences, Muhimbili University, P.O Box 65015, Dar es Salaam, Tanzania ; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: George M
authors.initials: GM
authors.lastname: Ruhago
authors.affiliation: Ministry of Health and Social Welfare, P.O Box 9083, Dar es Salaam, Tanzania ; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Frida N
authors.initials: FN
authors.lastname: Ngalesoni
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Ole F
authors.initials: OF
authors.lastname: Norheim
keywords: Cost; Cost-effectiveness; Rotavirus; Vaccine