RESEARCH – November 2012

Cost-effectiveness of rotavirus vaccines in Estonia

Authors: Kristi Liiv, Eda Tamm, Marje Oona, Eva Juus, Katrin Lutsar, Janek Saluse, Raul-Allan Kiivet

Articles PDF


Background. Rotavirus gastroenteritis is a widespread intestinal infection that causes a large part of infant mortality in developing countries. Although death cases are rare in developed countries, the burden to the health care system caused by milder cases  is considerable. Morbidity can be reduced by vaccination.

Objective. To evaluate the cost-effectiveness of vaccination against rotavirus with Rotarix or Rotateq compared to non-vaccination in Estonia from the perspective of the third party payer.

Methods. A Markov cohort model was constructed to fol low an approximate Estonian annual birth cohort of 16, 000 children until the age of five. Vaccine coverage was assumed to be 95%. The vaccine efficacy of Rotarix against mild and moderate rotavirus gastroenteritis cases was assumed to be 79% and against hospital ization-requiring severe cases, 96%. The efficacy of Rotateq was assumed to be 74% and 94%, respectively. The main outcome measures of the model were mild (no medical attention necessary), moderate (GP visit needed) and severe (hospitalized) rotavirus gastroenteritis cases. Based on quality of life lost in association with measured outcomes, quality-adjusted life-years (QALY) were calculated for the vaccination and non-vaccination cohorts. Costs included the expenses associated with treatment, prescription drugs, parent’s temporary work incapacity benefits and vaccine costs. Costs and effects were discounted using an annual discount rate of 5%.

Results. Approximately 90% of rotavirus gastroenteritis cases are prevented by vaccination. All cases of death would most likely be avoided. As compared to the nonvaccination arm, 55-57 QALYs are gained during the five-year period by vaccination. From the perspective of the third party payer, the incremental cost effectiveness ratio (ICER) for Rotarix and Rotateq vaccines compared to non-vaccination would be 13, 000–30, 000 €. The key impact factors for cost-effectiveness were the cost of vaccines and the number of cases requiring hospitalization.

Conclusions. Current analysis indicates that vaccination against rotavirus would prevent a considerable number of rotavirus gastroenteritis cases in Estonia. At the same time, vaccination costs exceed treatment cost savings fourfold.