Cost-effectiveness analysis of routine rotavirus vaccination in Brazil.

OBJECTIVE The objective of this study was to conduct a cost-effectiveness analysis of a universal rotavirus vaccination program among children < or = 5 years of age in Brazil. METHODS Considering a hypothetical annual cohort of approximately 3,300,000 newborns followed over 5 years, a decision-tree model was constructed to examine the possible clinical and economic effects of rotavirus infection with and without routine vaccination of children. Probabilities and unit costs were derived from published research and national administrative data. The impact of different estimates for key parameters was studied using sensitivity analysis. The analysis was conducted from both healthcare system and societal perspectives. RESULTS The vaccination program was estimated to prevent approximately 1,735,351 (54%) of the 3 210 361 cases of rotavirus gastroenteritis and 703 (75%) of 933 rotavirus-associated deaths during the 5-year period. At a vaccine price of 18.6 Brazilian reais (R$) per dose, this program would cost R$121,673,966 and would save R$38,536,514 in direct costs to the public healthcare system and R$71,778,377 in direct and indirect costs to society. The program was estimated to cost R$1,028 and R$1,713 per life-years saved (LYS) from the societal and healthcare system perspectives, respectively. CONCLUSIONS Universal rotavirus vaccination was a cost-effective strategy for both perspectives. However, these findings are highly sensitive to diarrhea incidence rate, proportion of severe cases, vaccine coverage, and vaccine price.