The cost effectiveness of rotavirus vaccination in Iran

Figures & data

Table 1. Model input parameter values and ranges.

	Variable	Estimate Base	Low	Hi	Source
Hospitalization rate (primary) Age group (in month)
	2–5	0.005	0.004	0.016	Estimated refer to appendix 1
	6–11	0.018	0.013	0.055
	12–23	0.020	0.014	0.062
	24–35	0.004	0.003	0.013
	36–59	0.004	0.003	0.011
Out Patient Rate (primary)
	2–5	0.023	0.012	0.053
	6–11	0.080	0.043	0.185
	12–23	0.091	0.048	0.211
	24–35	0.018	0.010	0.042
	36–59	0.016	0.009	0.037
Mortality rate from Rotavirus
	2–5	0.0003	0.0003	0.0004
	6–11	0.0001	0.0010	0.0012
	12–23	0.0006	0.0006	0.0007
	24–35	0.0001	0.0001	0.0001
	36–59	0.0001	0.0001	0.0001
Costs in Dollars per case
	Hospitalization	214	73	416	Estimated
	Out-Patient Visit	16	13	19	Estimated
	Loss of productivity (hospitalized)	161	3	834	Estimated
	Lose of productivity (outpatient)	54	3	278	Estimated
	Transportation (Hospitalized)	11	3	40	Estimated
	Transportation (outpatient)	4	2	13	Estimated
	Other societal cost	27	3	120	Estimated
	Vaccine cost per case	10	1	20	[16]
	Program cost per case	0.25	0.05	0.5	[16]
Other Epidemiologic parameters
	Ratio of second infection VS first	0.62	0.5	0.83	[6]
	Ratio of third infection VS first	0.4	0.28	0.59	[6]
Effectiveness parameters
	Discount rate	0.03	0	0.05	[50]
	Disability weight	0.119	0.086	0.152	[51]
Vaccine Efficacy in percent
	Hospitalization	93	75	95	[16]
	first year	93	75	95	[16]
	at or after 1 y of age	93	75	95	[16]
Outpatient
	first year	78	75	95	[16]
	at or first year of age	75	75	95	[16]
Death
	first year	75	75	95	[16]
	at or first year of age	93	75	95	[16]
Vaccine other parameters
	Coverage	0.966	0.85	0.99	[34]
	Wastage	0.05	0.02	0.15	[34]

Table 2. Result of the cost effectiveness analysis for a cohort of 1231735 children born in 2009 in Iran.

		Not Vaccinated	Vaccinated	Differences
Utilization
	Hospitalization	42310	3217	32092
	Out Patient visit	211802	53053	158750
	Death	1725	156	1591
Cost (in US dollar)
	Health Care	11,878,982	12,898,174	−1,019,192
	Societal	31,633,769	16,441,202	15,192,568
	Effectiveness (in DALY)	59957	5277	54680

Figure 1. The decision tree model. In this figure patient follow is shown. The first node represents the decision between the not vaccinated and vaccinated strategy (displayed as square). After the decision node a Markov node follows, where possible Markov-states are defined.

Figure 2. Results of one-way sensitivity analyses. This graph presents results of univariate sensitivity analyses from the health care (A) and societal perspective (B). The x-axis represents the ranges of the incremental cost-effectiveness ratios of vaccination in Iranian children when the baseline estimates of key parameters were varied over plausible ranges. The vertical line represents the base case incremental cost-effectiveness ratio of rotavirus vaccination. The negative values indicate saving per averted DALY.

Figure 3. The incremental cost- effectiveness ratio (ICER) for different price of vaccine from both health care and societal perspective.

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