Cost-effectiveness of a pentavalent human–bovine reassortant rotavirus vaccine for children ≤5 years of age in Taiwan

Abstract

Objective:

A Markov model was used to assess the impact of RV5, a pentavalent (G1, G2, G3, G4, P1A[8]) human bovine (WC3 strain) reassortant rotavirus vaccine, on reducing the healthcare burden and cost associated with rotavirus gastroenteritis (RGE) in Taiwan. Other cost-effectiveness analyses for rotavirus vaccination in industrialized countries have produced varying results depending on the input parameters assumed.

Methods:

Vaccination with RV5 is compared to no vaccination in a hypothetical cohort of Taiwanese children during their first 5 years of life to determine the per dose prices at which vaccination would be cost neutral or provide good value based on established standards from the healthcare (direct medical care costs only) and societal (all RGE-related costs) perspectives. The effects of vaccination on RGE healthcare utilization and days of parental work loss missed are based on results from the Rotavirus Efficacy and Safety Trial.

Results:

Without vaccination there would be 122,526 symptomatic episodes of RGE. Universal vaccination would reduce RGE-related deaths, hospitalizations, emergency department, and outpatient visits by 91.7%, 92.1%, 83.7%, and 73.4%, respectively. The price per dose at which vaccination would be cost-neutral is US$ 21.80 (688 NTD) and US$ 26.20 (827 NTD) from the healthcare and societal perspectives, respectively. At $25 per dose, the cost per QALY gained is US$ 2261 (71,335 NTD) from the healthcare perspective and cost saving from the societal perspective.

Key limitations:

The model only assesses the effect of RV5 on vaccinated children and does not account for herd immunity. However, given that high levels of coverage are anticipated in Taiwan, the effects of herd immunity are likely to be short-term.

Conclusion:

A pentavalent rotavirus vaccination program is likely to substantially reduce the healthcare burden associated with rotavirus gastroenteritis at a cost per QALY ratio within the range defined as cost-effective.

Key words::

• Cost-effectiveness
• Rotavirus gastroenteritis
• Rotavirus vaccination
• RV5
• Taiwan

Transparency

Declaration of funding

This study was funded by Merck & Co., Inc., North Wales, Pennsylvania, USA.

Declaration of financial/other relationships

R.F.I., A.C.E., and J.R.C. are employees of and own Merck & Co. stock. C.L. is an employee of MSD, Taipei, Taiwan. P.Y.C. was an investigator who enrolled subjects at the study sites and coordinated the clinic sites for the Mast et al. 2010 study. As an investigator, he was compensated by Merck & Co. for all activities related to the execution of the study.

Acknowledgments

The authors would like to thank Karen Collins of JK Associates, Inc., Conshohocken, PA, for assistance with manuscript preparation on behalf of Merck & Co., Inc.