title: Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection.
abstract: BACKGROUND
  Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule.
  
  
  METHODS
  We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course.
  
  
  RESULTS
  Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode.
  
  
  CONCLUSIONS
  Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions.
authors.affiliation: Department of Industrial Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA. Electronic address: yamind@post.tau.ac.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Yamin
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Atkins
authors.affiliation: Sanofi Pasteur MSD, Lyon, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Remy
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005602:France; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D008962:Models, Theoretical; D011788:Quality of Life; D012400:Rotavirus Infections / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics* / Q000627:therapeutic use*; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D022243:Rotavirus Vaccines
keywords: cost-effectiveness of rotavirus; herd immunity; rotavirus model; rotavirus vaccination