OBJECTIVES:

Rotavirus (RV) is the most common cause of severe acute gastroenteritis (GE) among children younger than five years. Previous studies have demonstrated that rotavirus vaccination has high potential in reducing severe childhood gastroenteritis. This study aims to evaluate the cost-effectiveness of three dose pentavalent rotavirus vaccine (RV5) compared to no vaccination in the prevention of RVGE in the Netherlands.

METHODS:

An age-structured deterministic dynamic model of rotavirus transmission was developed using latest epidemiological as well as direct and indirect cost data. The cost-effectiveness analysis takes the societal perspective over a time horizon of 50 years. The population was stratified into a Maternal-Susceptible-Exposed-Infected-Recovered-Susceptible (MSEIRS) compartmental framework. The model includes seasonal variation of rotavirus transmission, allows for multiple infections per person, and three levels of disease severity. For calibration of unknown epidemiological parameters, age-dependent susceptibility of individuals was modelled by fitting different values of susceptibility rate for different age group to weekly national rotavirus incidence from 2006 to 2013 in the Netherlands. The model was programmed using Wolfram Mathematica 11.2 software.

RESULTS:

The vaccination program avoids 5,313,520.00 RVGE cases over 50 years (98% reduction). Similarly, there was a reduction in cumulative cost from €107.32 to €30.71 per person after vaccination with RV5. The reduction in the cost by €76.6 with improvement in QALYs by 2.31×10^-6 per person implies that the vaccination strategy is dominant and cost-saving. Sensitivity analysis indicates that the results were most sensitive to productivity loss, number of hospitalizations, outpatient visits, and the health utility values.

CONCLUSIONS:

The RV5 immunization program may lead to reduced RVGE morbidity and substantially lower treatment and indirect medical costs compared to vaccination costs resulting in cost saving.