BACKGROUND: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq® (RV5)) in Iran, from the viewpoints of Iran's health system and society.
METHODS: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results.
RESULTS: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario.
CONCLUSION: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
Bibliographical noteCopyright © 2014 Elsevier Ltd. All rights reserved.
This work was supported by the ProVac International Working Group, which is funded entirely by a grant from the Bill & Melinda Gates Foundation (grant number: OPP1032888).
This technical and collaborative project gained significant strength by thoughtful advice and great technical assistances from Iran MOHME, the National Immunization Technical Advisory Group (NITAG), WHO-Iran, Regional Office for the Eastern Mediterranean, Agence de Médecine Préventive (AMP), PATH, London School of Hygiene & Tropical Medicine (LSHTM), Pan American Health Organization (PAHO), and the Sabin Vaccine Institute. The authors would like to thank kindly all advisors and colleagues, especially Céline Hoestlandt, Carlos Lara, Julia Blau, Dr. Andy Clark, Gabriela Felix, Diane Coraggio, and Dr. Nadia Teleb for their valuable technical support.
- Rotavirus diarrhea
- TRIVAC model