title: Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia.
abstract: Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction.
  
  
  
  We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations.
  
  
  
  Relative to the baseline period (1997-2006), over the 6years (2007-2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program.
  
  
  
  The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted bypre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia. Electronic address: j.reyes@unsw.edu.au.
authors.forename: J F
authors.initials: JF
authors.lastname: Reyes
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: J G
authors.initials: JG
authors.lastname: Wood
authors.affiliation: Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Beutels
authors.affiliation: Discipline of Child and Adolescent Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Macartney
authors.affiliation: Discipline of Child and Adolescent Health and School of Public Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Menzies
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Mealing
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: A T
authors.initials: AT
authors.lastname: Newall
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D005260:Female; D005759:Gastroenteritis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012400:Rotavirus Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data
chemical_list: D022243:Rotavirus Vaccines
keywords: Cost-effectiveness; Economic evaluation; Post-implementation; Retrospective; Rotavirus; Vaccination