Elsevier

Vaccine

Volume 27, Issue 29, 12 June 2009, Pages 3904-3911
Vaccine

An economic analysis of rotavirus vaccination in Italy

https://doi.org/10.1016/j.vaccine.2009.04.002Get rights and content

Abstract

We have evaluated health and economic benefits of a universal infant vaccination with two rotavirus vaccines registered in Italy, on the bases of the burden of rotavirus gastroenteritis (RVGE) in a birth cohort of 520,000 Italian infants followed until 5 years of age. Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives of the Italian National Health Service (NHS) and society. According to our estimates, a universal rotavirus vaccination program would avoid 10,679 hospitalizations, 39,202 emergency visits, and 44,223 at home visits. At €65.6 per vaccination courses, the program would cost €30,700,800 and realize a net loss of €9,057,928 from the Italian NHS perspective. On the contrary, the program would provide a net savings of €24,324,198 from the societal perspective. From the Italian NHS perspective, the break-even price per vaccination course should be reduced at least to €46.25 to achieve a zero cost-effectiveness ratio.

Introduction

Rotavirus is a major cause of acute gastroenteritis in children 0–5 years of age in Italy as well as in other European countries [1], [2]. In developing countries, rotavirus gastroenteritis (RVGE) is one of the most common cause of severe acute diarrhea, responsible for about 440,000 deaths each year [3]. Although the disease is relatively mild in industrialized countries and deaths occur infrequently, the burden of disease due to rotavirus remains considerable. Within the European Union it has been estimated that 3.6 million episodes of RVGE occur annually among the 23.6 million children under 5 years of age; furthermore it has been calculated that RVGE is responsible for 231 deaths, more than 87,000 hospitalizations, and about 700,000 outpatients visits annually [1].

The burden of the medical costs for RVGE has been recently calculated for some European countries [4], [5], [6], [7]. The results of the economic evaluations suggest that hospital admissions generate significant medical treatment costs throughout Europe. Moreover, important economic burdens are associated with less severe cases treated either in primary care or at home and the indirect costs borne by families, including lost time from work. As two live attenuated oral rotavirus vaccines (Rotarix® and RotaTeq® vaccines) become available, the evaluation of the economic burden on health care systems and families is required to compare the costs of vaccination to the economic benefits. The purpose of this article is to evaluate the global cost of RVGE and the cost of a universal rotavirus vaccination program in infants in Italy using either Rotarix® or RotaTeq® vaccines both from the National Health Service (NHS) and the societal perspectives.

Section snippets

Model design

We have adopted a decision analytic model from a cost-effectiveness analysis model constructed to estimate the economic impact of a national rotavirus immunization program in the United States [8]. A hypothetical birth cohort of 520,000 Italian infants has been followed until 5 years of age [9], comparing RVGE cases, health care consumptions and associated costs in the current context (rotavirus vaccination at the present is not offered by the public health services and it is only sporadically

Base case estimates

The health outcomes in absence and with a rotavirus vaccination program in a birth cohort of 520,000 Italian infants are those presented in Table 3. The burden of RVGE cases within the cohort from birth to 5 years of age, in the absence of a universal rotavirus vaccination program, would consist in 13,520 hospitalization cases, 49,400 emergency visits, and 59,280 at home visits.

The percentages of avoided RVGE cases would be 79% for the hospitalized cases (10,679 avoided cases), 79% for the

Discussion

Paediatric RVGE represents an important burden in Italy, as well as in other developed and developing countries, both from the health and economic points of view. According to the epidemiologic data based on the REVEAL estimates, 13,520 hospitalizations, 49,400 emergency visits and 59,280 FP visits are expected for every birth cohorts in Italy followed up to 5 years of age, with an associated direct medical costs of €27,439,739 and of €70,518,128 when indirect costs are added.

A universal

References (16)

  • F. Huet et al.

    Burden of paediatric rotavirus gastroenteritis and potential benefits of a universal rotavirus vaccination programme with RotaTeq in France

    Vaccine

    (2007)
  • M. Soriano-Gabarrò et al.

    Burden of rotavirus disease in European Union countries

    Ped Infect Dis J

    (2006)
  • A. Marocco et al.

    Ricoveri per enteriti da rotavirus in Italia valutati mediante analisi delle Schede di Dimissione Ospedaliera negli anni 2001–2003

    Ig San Pubbl

    (2006)
  • U.D. Parashar et al.

    Global illness and deaths caused by rotavirus in children

    Emerg Infect Dis

    (2003)
  • J.A. Roberts et al.

    The study of infectious intestinal disease in England: socio-economic impact

    Epidemiol Infect

    (2003)
  • P. Van Damme et al.

    Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe 2004–2005: the REVEAL Study

    J Infect Dis

    (2007)
  • C. Giaquinto et al.

    Costi della gastroenterite da rotavirus acquisita in comunità in età pediatrica a Padova in Italia

    PharmacoEconomics—Italian Research Articles

    (2007)
  • C. Giaquinto et al.

    Costs of community-acquired pediatric rotavirus gastroenteritis in 7 European countries: the REVEAL Study

    J Infect Dis

    (2007)
There are more references available in the full text version of this article.

Cited by (24)

  • Cost-effectiveness of rotavirus vaccination in Turkey

    2017, Journal of Microbiology, Immunology and Infection
    Citation Excerpt :

    Immunization plays a significant role for RV related morbidity and mortality and currently two vaccines are available.10 Rotarix (GlaksoSmithKline, Rixenrant, Belgium) and RotaTeq ​(Merck Sharp&Dohme Corp., Whitehouse Station NJ, USA), two vaccines developed against RV infections, are reported to reduce hospital and emergency room admissions by 90%.9 These vaccines which have been used in many countries since 2006 are currently included in routine vaccination programs in more than 100 countries.11

  • Economic and psychosocial Impact of rotavirus infection in Spain: A literature review

    2014, Vaccine
    Citation Excerpt :

    The cost of acute rotavirus gastroenteritis varies considerably in other European countries, with figures ranging from EUR 7.5 million a year in the Netherlands [21] and Greece [22] to EUR 63 million in France [23]. In Italy, the figure is similar to in Spain, at around EUR 28 million [20]. In Spain, the estimated cost of hospitalisation per episode of acute gastroenteritis ranges from EUR 1000 to EUR 1700 [10,11,16], although figures are higher for nosocomial infections due to the need for longer hospital stays.

  • The impact of new vaccine introduction on immunization and health systems: A review of the published literature

    2012, Vaccine
    Citation Excerpt :

    In a number of settings, insufficient funding [22] and loss of donor support [37] resulted in vaccine shortages and program interruptions. A decrease in ambulatory consultations and hospitalizations, disease-related complications, and long-term sequelae associated with diseases prevented by the newly introduced vaccines was reported from developing and industrialized countries; these led to reductions in health care utilization, and in some cases resulted in changes in treatment recommendations [31,44,55,59–89] (Table 3). The introduction of PCV in the United States resulted in a decrease in the mortality in sickle cell patients; however, guidelines for penicillin prophylaxis remained unchanged, because not all pneumococcal serotypes are covered by currently available vaccines [90].

  • Cost-effectiveness of rotavirus vaccination in Bolivia from the state perspective

    2011, Vaccine
    Citation Excerpt :

    The results of published CEAs for rotavirus vaccination have varied. Out of 36 published studies, universal rotavirus vaccination was determined to be potentially cost saving in three studies [31–33], potentially cost-effective in 27 studies [3,4,6,13,29,30,32,34–52], unlikely to be cost-effective in six studies [53–58], and inconclusive in one study [59]. Estimates of costs per DALY averted ranged from US$15.32 in middle-income Asian countries (vaccine price of US$2 per course) [6] to US$10,656 in Chile (vaccine price of US$24 per course) [7].

View all citing articles on Scopus
View full text