1 / 22

Cost –effectiveness analysis of a Universal Rotavirus Immunization Program in Japan

Cost –effectiveness analysis of a Universal Rotavirus Immunization Program in Japan. Introduction. Rotavirus is the major cause of severe dehydrating diarrhea Estimated 611,000 deaths annually among under-five in developing countries.

abia
Download Presentation

Cost –effectiveness analysis of a Universal Rotavirus Immunization Program in Japan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cost –effectiveness analysis of a Universal Rotavirus Immunization Program in Japan

  2. Introduction • Rotavirus is the major cause of severe dehydrating diarrhea • Estimated 611,000 deaths annually among under-five in developing countries. • Two live oral rotavirus vaccines - Rota Teq and Rota Trix licensed in >100 countries • Incorporated in routine childhood immunization programs of >20 countries.

  3. Objective: • To evaluate cost-effectiveness analysis of rotavirus vaccination, with view to facilitate the decision of whether rotavirus vaccine should be included in the universal immunization program in Japan.

  4. My learning objective: • To learn about cost-effectiveness analysis.

  5. Mathematical Modeling: • Becoming an increasingly important subject as computers expand our ability to translate mathematical equations and formulations into concrete conclusions concerning the world, both natural and artificial, that we live in.

  6. Process of mathematical Modeling

  7. Method Mathematical modeling Using hypothetical 2009 birth cohort of 1.1 million Japanese children Follow-up model for 5 years. A Markov model was constructed The costs and outcomes of vaccination was compared for 2 different scenarios: - Absence of rotavirus immunization program and - Implementation of a universal rotavirus immunization program Cost-effectiveness analysis Interpretation and explanation of the result

  8. Cont… • The model evaluated the potential impact of rotavirus vaccination on • direct medical costs • indirect costs • quality of life (for hospitalization and outpatient visits) • The immunization program was evaluated - From a societal perspective and - The Health perspective.

  9. Assumptions • The complete course of Rotarix (2 doses) or RotaTeq (3 doses) would be administered concomitantly with other vaccines to all children at 0–5 months of age. • The same efficacy levels were assumed for both vaccines • Vaccine efficacy • Hospitalizations - 95% • Outpatients Visits - 85% • Vaccination cost of ¥20,000 per course was assumed for both vaccines (based on CDC price list including cost of administration)

  10. Assumptions (cont…) Direct medical cost • outpatient visit - ¥13,830 • Hospitalization - ¥138,298 Indirect medical cost • Productivity loss (number of days) • Outpatient visit – 2 days • Hospitalization – 5 days • Productivity loss per day • Hospitalization - ¥ 38,544 per caregiver • Outpatient visit - ¥ 15,418 per caregiver Annual discount rate- 5%

  11. Measure of benefit: • The benefit measure was the number of quality-adjusted life-years (QALYs). • Program was considered cost-effective if the ICER was less than ¥ 6 million per QALY gained.

  12. Analysis of uncertainty: • One-way sensitivity analyses were performed to examine the effects of changes in following variables on the base results. • The direct medical cost and the productivity loss per case (±25%from the base case), • The utility (95% confidence interval) , • The vaccine efficacy (95%CI), • The vaccine cost per course (±25% from the base case), and • The discount rate (3% used in studies conducted in other industrialized countries.

  13. Result and Discussion

  14. Table 3 Cont…

  15. Fig 1: Cost structure of rotavirus hospitalizations and out patient visit before the implementation of rotavirus vaccination

  16. Fig 2 : The direct medical cost and indirect medical cost of rotavirus hospitalization and out patient visits according to the incidence of the hospitalization and outpatient visit

  17. Fig 3 : Sensitivity Analysis result

  18. Fig 4 : Sensitivity Analysis result (Health care perspective)

  19. Fig 4 : Sensitivity Analysis result (Societal perspective)

  20. Conclusion: • A universal rotavirus immunization program would prevent 85% of the rotavirus-associated hospitalizations and outpatient visits. • The universal immunization program was found to be cost-effective from the societal perspective for any of the previously reported incidence rates of rotavirus-associated hospitalization. • Thus, the introduction of the rotavirus vaccine into the childhood immunization schedule and its co-administration with other childhood vaccines will be a cost-effective public health intervention in Japan.

  21. Limitation of this study • Authors did not consider any effects that may arise from the differences in the serotypes. • The events of rotavirus deaths, nosocomial infections, and home care cases were not included because of the non-availability of the relevant data. • This model did not take herd immunity into account.

  22. Success story • Australia, where rotavirus vaccine was introduced into the universal immunization program since 2007, a cost-effectiveness analysis showed that the ICER per QALY gained from the implementation of the immunization program was lesser than the maximum cost-effectiveness threshold when the base case incidence of rotavirus- associated hospitalizations was applied.

More Related