title: Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system.
abstract: OBJECTIVE
  To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes.
  
  
  METHODS
  The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model.
  
  
  RESULTS
  We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles.
  
  
  CONCLUSIONS
  We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency.
authors: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia. drtharani@gmail.com.
authors: Tharani
authors: T
authors: Loganathan
authors: Modeling and Economics Unit, Public Health England, London, UK.|Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Mark
authors: M
authors: Jit
authors: Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
authors: Raymond
authors: R
authors: Hutubessy
authors: Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Julius Centre University of Malaya, University of Malaya, Kuala Lumpur, Malaysia.
authors: Chiu-Wan
authors: CW
authors: Ng
authors: Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia.|University Malaya Paediatrics and Child Health Research Group, Kuala Lumpur, Malaysia.
authors: Way-Seah
authors: WS
authors: Lee
authors: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors: Stéphane
authors: S
authors: Verguet
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D055818:Public-Private Sector Partnerships; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics*; D019472:Universal Health Insurance
chemical_list: D022243:Rotavirus Vaccines
keywords: catastrophic expenditure; cobertura sanitaria universal; couverture santé universelle; dépenses catastrophiques; equidad; equity; gasto catastrófico; mixed public-private healthcare systems; pauvreté; pobreza; poverty; sistemas mixtos público-privado; systèmes de soins de santé mixte public-privé; universal health coverage; vaccines; vaccins; vacunas; équité