Rotavirus Vaccination is Cost Effective and Saves Lives, Analysis Finds: Public Health Watch

When it comes to rotaviruses, numbers remain the key.

According to the most recent estimates available, some 500,000 children die annually as a result of contracting diarrheal diseases in general—meaning that they are the cause of death in 1 out of every 10 cases of child mortality globally. Most of these deaths occur in the developing world, and as many as one-third, if not more, can be attributed to rotaviruses.

Of course, viral diarrhea is highly contagious, and the vast majority of cases can be attributed to poor hand hygiene and sanitary practices/conditions. A vaccine against rotaviruses has been available for more than a decade, and to date more than 90 countries have introduced routine vaccination, thanks in large part to financial assistance from groups such as Gavi, the vaccine alliance.

However, as with everything in global health care, the successful implementation of vaccination programs often comes down to another number: the price tag. Thankfully, there’s some good news to report in this regard.

In an analysis published in the December issue of The Lancet Global Health, investigators from PATH, the London School of Hygiene & Tropical Medicine, and the US Centers for Disease Control and Prevention, analyzed the potential costs of rotavirus vaccination for 10 successive birth cohorts (from 2018 through 2027) in 73 countries eligible for Gavi support, compared with no vaccination. The study team used a “deterministic cohort model” to calculate numbers of rotavirus gastroenteritis cases, outpatient visits, hospitalizations, and deaths between birth and 5 years, with and without rotavirus vaccination. They also attempted to calculate treatment costs from both a government and societal perspective.

They found that over the 10-year study period, rotavirus vaccination would prevent nearly 600,000 deaths in Gavi-eligible countries. Governments in these countries would save nearly $500 million through the elimination of some of the more than 80 million outpatient health care provider visits and nearly 8 million hospitalizations that would be required to treat those sickened by rotaviruses. In addition, vaccination could yield nearly $900 million in savings from a societal perspective, the authors found.

“This analysis confirms that, despite recent changes to the vaccine landscape, rotavirus vaccines remain a lifesaving and cost-effective intervention for the countries that need them most,” co-author Clint Pecenka, director of health economics at PATH’s Center for Vaccine Innovation and Access, told Contagion®. “Gavi’s support for rotavirus vaccines is working, and countries that have not yet introduced rotavirus vaccines, particularly low- and middle-income Gavi countries, are missing out on an opportunity to save children’s lives and help families by preventing emotional and financial suffering. The last decade of Gavi-supported rotavirus vaccination has saved hundreds of thousands of children’s lives from diarrhea. By working together to continue supporting rotavirus vaccination in all countries worldwide, we could help save as many as 600,000 more in the next decade.”

Pecenka and his colleagues based their analysis on estimated costs-per-dose for the 4 currently available vaccines: Rotarix, RotaTeq, Rotovac, and Rotasiil. The countries that failed to introduce rotavirus vaccine when they were still eligible for Gavi support are not automatically accessing Gavi negotiated prices; for these countries, prices were estimated from the WHO vaccine, price, and procurement database.

Representatives of Gavi could not be reached on deadline. However, as the authors of The Lancet Global Health paper wrote, “Rotavirus vaccination is an impactful and cost-effective intervention for a disease that causes around 200,000 deaths in children younger than 5 years each year. This analysis serves as an important reminder to continue to prioritize immunization in the context of efforts to achieve universal health coverage, health equity, and other important priorities. Immunization should continue to be an essential component of these efforts, especially for countries that face decreasing international financial assistance and pressure to achieve additional objectives. Countries transitioning away from Gavi support should explore newly prequalified vaccines as an option that might provide enhanced value for money. Countries that have yet to introduce rotavirus vaccination should actively consider the potential benefits and cost-effectiveness of rotavirus vaccination as a step to achieving broader health goals.”