Author(s):
Lourenço Guimarães, Esperança ; Chissaque, Assucênio ; Pecenka, Clint ; Clark, Andrew ; Vaz, Basília ; Banze, Arlindo ; Canana, Neide ; Romão, Clésio ; do Rosário Oliveira Martins, Maria ; de Deus, Nilsa ; Debellut, Frédéric
Date: 2022
Persistent ID: http://hdl.handle.net/10362/145718
Origin: Repositório Institucional da UNL
Subject(s): Cost-effectiveness; Diarrhea; Modelling; Mozambique; Rotavirus; UNIVAC; Vaccination; Molecular Medicine; Immunology and Microbiology(all); veterinary(all); Public Health, Environmental and Occupational Health; Infectious Diseases; SDG 3 - Good Health and Well-being
Description
Funding Information: The authors received funding from Bill and Melinda Gates Foundation (OPP1147721), through PATH subaward number: GAT.2111-01707508-SUB. Funding Information: We thank the EPI and the NITAG, from Mozambique for their support and commitment to the present analysis. We also thank PATH team for the technical support and Laura Kallen (from PATH) for linguistic revision of the manuscript. The authors received funding from Bill and Melinda Gates Foundation (OPP1147721), through PATH subaward number: GAT.2111-01707508-SUB. Publisher Copyright: © 2022 The Authors
Introduction: Rotavirus is one of the most common cause of severe gastroenteritis in children, with the largest mortality burden in low- and middle-income countries. To prevent rotavirus gastroenteritis, Mozambique introduced ROTARIX® vaccine in 2015, however, its cost-effectiveness has never been established in the country. In 2018, additional vaccines became available globally. This study estimates the cost-effectiveness of the recently introduced ROTARIX in Mozambique and compares the cost-effectiveness of ROTARIX®, ROTAVAC®, and ROTASIIL® to inform future use. Methods: We used a decision-support model to calculate the potential cost-effectiveness of vaccination with ROTARIX compared to no vaccination over a five-year period (2016–2020) and to compare the cost-effectiveness of ROTARIX, ROTAVAC, and ROTASIIL to no vaccination and to each other over a ten-year period (2021–2030). The primary outcome was the incremental cost per disability-adjusted life-year (DALY) averted from a government perspective. We assessed uncertainty through sensitivity analyses. Results: From 2016 to 2020, we estimate the vaccine program with ROTARIX cost US$12.3 million, prevented 4,628 deaths, and averted US$3.1 million in healthcare costs. The cost per DALY averted was US$70. From 2021 to 2030, we estimate all three vaccines could prevent 9,000 deaths and avert US$7.8 million in healthcare costs. With Global Alliance for Vaccines and Immunization (Gavi) support, ROTARIX would have the lowest vaccine program cost (US$31 million) and 98 % probability of being cost-effective at a willingness-to-pay threshold of 0.5x GDP per capita. Without Gavi support, ROTASIIL would have the lowest vaccine program cost (US$75.8 million) and 30 % probability of being cost-effective at the same threshold. Conclusion: ROTARIX vaccination had a substantial public health impact in Mozambique between 2016 and 2020. ROTARIX is currently estimated to be the most cost-effective product, but the choice of vaccine should be re-evaluated as more evidence emerges on the price, incremental delivery cost, wastage, and impact associated with each of the different rotavirus vaccines.
