An economic analysis of rotavirus vaccination in Italy
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
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