April 24, 2012 — A supplement to the journal Vaccine provides evidence for the success of rotavirus vaccine in saving lives of children in developing countries. One study projects health outcomes and direct costs until 2030, comparing immunized with nonimmunized birth cohorts to estimate lives saved and economic costs.
Rotavirus is the leading cause of fatal diarrhea in children under age 5 years, and 95% of the 450,000 annual deaths in this group occur in the developing nations of Asia and Africa, as quoted in an accompanying news release. Millions more young patients must be hospitalized.
In 2009 the World Health Organization recommended that all national immunization programs include rotavirus vaccine. The 30 countries that have done so report dramatic declines in deaths and hospitalizations. The GAVI Alliance is taking the initiative in the effort to immunize children in more than 40 needy nations, charging $2.50 per dose, as described in the news release.
Deborah E. Atherly, MPH, PhD, from the Rotavirus Vaccine Program, PATH, Seattle, Washington, and colleagues used a decision-analytic model that considered vaccine efficacy, immunization rates, disease burden, and costs. They followed annual birth cohorts for 5 years and estimated health outcomes and healthcare costs, noting whether each child had been vaccinated.
Costs included diagnostic testing, supplies, medication, facilities, personnel, and vaccination. Outcome measures were deaths and disability-adjusted life-years (DALYs), which are years of life lost to death and disability. The cost-effectiveness ratio was expressed as US dollars per DALY averted.
The researchers conclude that between 2011 and 2030, "rotavirus vaccination for 72 GAVI-eligible countries is projected to avert the deaths of more than 2.4 million children, and prevent more than 83 million DALYs." That translates into preventing 180,000 of the 429,000 estimated annual rotavirus deaths in these nations. The cost per DALY averted was $42 for all GAVI countries over the projected period.
The effects will be most striking until 2019, the investigators note, as nations introduce the vaccine. Regional differences in cost-effectiveness and health outcomes reflect the underlying disease burden, rather than vaccine efficacy, they write.
Rotavirus Vaccination Worthwhile, Even When Efficacy Is Reduced
This and other studies published in the supplement indicate that rotavirus vaccination is worthwhile, despite lower efficacy rates in developing countries (which reflect both the more recent vaccination programs and the more severe cases). The vaccine is particularly effective against more serious disease.
"The trend towards greater efficacy against the more severe forms of rotavirus disease observed in several studies…suggests that the mortality reductions due to vaccination may be higher than what may be estimated using the estimates of efficacy against severe diarrhoea, which was the primary end point of most clinical trials," write Thomas Cherian, MD, and colleagues from the World Health Organization in an accompanying editorial.
Limitations of the study include use of diphtheria, pertussis, and tetanus vaccine coverage as a proxy for rotavirus vaccination and difficulty predicting when countries will begin rotavirus vaccination. "We have illustrated a snapshot of one potential demand scenario that attempts to capture the impact of rotavirus vaccines in all GAVI-eligible countries," the researchers write.
"As the GAVI Alliance is bridging the funding gap for new vaccines, and many countries are applying for financial support, the major impact of rotavirus vaccines on child mortality and health in the hardest hit populations may soon be realized," the authors conclude.
The study was funded by PATH's Rotavirus Vaccine Program under a grant from the GAVI Alliance. The study authors and editorialists have disclosed no relevant financial relationships.
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