Constructing a cost-effectiveness analysis for a vaccine to prevent rotavirus

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Constructing a cost-effectiveness analysis for a
vaccine to prevent rotavirus

• Roseann Dial RN
• N287E

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What is rotavirus

• The most common cause of severe diarrhea in
  children throughout the world
• Causes a highly contagious gastroenteritis that
  generally begins with fever and vomiting followed
  by mild to severe diarrhea lasting up to a week.
• Severe vomiting and diarrhea can lead to
  dehydration that may require hospitalization and
  can be fatal

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Burden of the disease

• By the time they are five years old, more than
  95 of the worlds children will have been
  infected.
• Worldwide, rotavirus is responsible for over 2
  million hospitalizations and 400,000 - 600,000
  deaths each year
• In the United States rotavirus accounts for as
  much as 5 of all pediatric hospitalizations and
  approximately 30 of all hospitalizations for
  diarrhea

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Burden of the disease

• In 2002, one of every 77 children in the United
  States was admitted to the hospital for a
  rotavirus infection. This equals roughly 50,000
  hospitalizations. Another 400,000 physician
  visits were attributed to the virus. The death
  rate is about 50 to 70 children per year

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Financial burden of rotavirus

• Nearly one billion dollars a year
• 264 million related to health care
• 22 million for non-health care related costs (
  transportation, diapers, childcare, replacement
  fluids)

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no diarrhea
Decision tree for rotavirus immunization program
in the US. Current practice of no vaccination vs.
vaccination program
Choice Chance Outcome
mild
vaccinated
provider visit
ED visit
hospitalization
Vaccination program
adverse reaction
death
no diarrhea
mild
provider visit
Not vaccinated
ED visit
hospitalization
death
Not ill
No diarrhea
no diarrhea
mild
No vaccination program
provider visit
ED visit
Ill with diarrhea
hospitalization
Adapted from Tucker et al (1998)
death
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Cost-effectiveness issues

• A cost-effectiveness analysis attempts to find
  the best alternative intervention or treatment
  that will achieve a desired result
• In order to perform a cost-effectiveness analysis
  the total cost of the disease and the total cost
  of the vaccination program must be calculated
• Would include direct and indirect health care
  costs and cost to society

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RotaTeq vaccine

• 96 reduction in hospitalizations
• 94 reduction in emergency department visits
• 74 decrease in the disease
• Could lead to a combined savings of over 250
  million

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Further areas to discuss

• Impact on developing nations lives saved are
  lives to feed/support
• Vaccine versus oral rehydration solution (60/
  dose versus 2.
• Previous vaccine did not develop intussusception
  until after 1.5 million doses