title: Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option.
abstract: BACKGROUND
  Rotavirus infection causes considerable disease burden of acute gastroenteritis (AGE) hospitalization and death among children less than 5 years in China. Although two rotavirus vaccines (Rotarix and RotaTeq) have been licensed in more than 100 countries in the world, the Lanzhou Lamb rotavirus vaccine (LLR) is the only vaccine licensed in China. This study aims to forecast the potential impacts of the two international vaccines compared to domestic LLR.
  
  
  METHODS
  An economic evaluation was performed using a Markov simulation model. We compared costs at the societal aspect and health impacts with and without a vaccination program by LLR, Rotarix or RotaTeq. Parameters including demographic, epidemiological data, costs and efficacy of vaccines were obtained from literature review. The model incorporated the impact of vaccination on reduction of incidence of rotavirus infection and severity of AGE indicated by hospitalization, inpatient visits and deaths. Outcomes are presented in terms of quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio (ICER) compared to status quo.
  
  
  RESULTS
  In a hypothetical cohort of 100,000 infants, the two international vaccines showed very good cost-effectiveness, with ICER of Rotateq and Rotarix shifting from LLR of $1715.11/QALY and $2105.66/QALY, respectively. Rotateq and Rotarix had significantly decreased incidence compared to LLR, particularly among infants aged 6 months to 2 years.
  
  
  CONCLUSIONS
  RotaTeq is expected to introduce in the national routine immunization program to reduce disease burden of rotavirus infection with universal coverage.
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Shuhui
authors.initials: S
authors.lastname: Cui
authors.affiliation: School of Public Health, Shandong University, Jinan, China. gai-r@ncchd.go.jp.|Department of Health Policy, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan. gai-r@ncchd.go.jp.
authors.forename: Ruoyan Gai
authors.initials: RG
authors.lastname: Tobe
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Xiuting
authors.initials: X
authors.lastname: Mo
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Lingzhong
authors.initials: L
authors.lastname: Xu
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Shixue
authors.initials: S
authors.lastname: Li
mesh_terms: D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012401:Rotavirus / Q000276:immunology; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000191:economics* / Q000627:therapeutic use; D014613:Vaccines, Attenuated / Q000191:economics
chemical_list: C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: China; Cost-effectiveness; Rotavirus; Routine immunization; Vaccination