Constructing a cost-effectiveness analysis for a vaccine to prevent rotavirus

1. Constructing a cost-effectiveness analysis for a vaccine to prevent rotavirus Roseann Dial RN N287E

2. What is rotavirus • The most common cause of severe diarrhea in children throughout the world • Causes a highly contagious gastroenteritis that generally begins with fever and vomiting followed by mild to severe diarrhea lasting up to a week. • Severe vomiting and diarrhea can lead to dehydration that may require hospitalization and can be fatal

3. Burden of the disease • By the time they are five years old, more than 95% of the world’s children will have been infected. • Worldwide, rotavirus is responsible for over 2 million hospitalizations and 400,000 - 600,000 deaths each year • In the United States rotavirus accounts for as much as 5% of all pediatric hospitalizations and approximately 30% of all hospitalizations for diarrhea

4. Burden of the disease • In 2002, one of every 77 children in the United States was admitted to the hospital for a rotavirus infection. This equals roughly 50,000 hospitalizations. Another 400,000 physician visits were attributed to the virus. The death rate is about 50 to 70 children per year

5. Financial burden of rotavirus • Nearly one billion dollars a year • $264 million related to health care • $22 million for non-health care related costs ( transportation, diapers, childcare, replacement fluids)

6. no diarrhea Decision tree for rotavirus immunization program in the US. Current practice of no vaccination vs. vaccination program Choice Chance Outcome mild vaccinated provider visit ED visit hospitalization Vaccination program adverse reaction death no diarrhea mild provider visit Not vaccinated ED visit hospitalization death Not ill No diarrhea no diarrhea mild No vaccination program provider visit ED visit Ill with diarrhea hospitalization Adapted from Tucker et al (1998) death

7. Cost-effectiveness issues • A cost-effectiveness analysis attempts to find the best alternative intervention or treatment that will achieve a desired result • In order to perform a cost-effectiveness analysis the total cost of the disease and the total cost of the vaccination program must be calculated • Would include direct and indirect health care costs and cost to society

8. RotaTeq vaccine • 96% reduction in hospitalizations • 94% reduction in emergency department visits • 74% decrease in the disease • Could lead to a combined savings of over $250 million

9. Further areas to discuss • Impact on developing nations; lives saved are lives to feed/support • Vaccine versus oral rehydration solution ($60/ dose versus $2. • Previous vaccine did not develop intussusception until after 1.5 million doses