Tate Jacqueline E, Rheingans Richard D, O'Reilly Ciara E, Obonyo Benson, Burton Deron C, Tornheim Jeffrey A, Adazu Kubaje, Jaron Peter, Ochieng Benjamin, Kerin Tara, Calhoun Lisa, Hamel Mary, Laserson Kayla, Breiman Robert F, Feikin Daniel R, Mintz Eric D, Widdowson Marc-Alain
Centers for Disease Control and Prevention, Atlanta,GA 30333, USA.
J Infect Dis. 2009 Nov 1;200 Suppl 1:S76-84. doi: 10.1086/605058.
The projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds are available.
Hospital records, health utilization surveys, verbal autopsy data, and surveillance data on diarrheal disease were used to determine rotavirus-specific rates of hospitalization, clinic visits, and deaths due to diarrhea among children <5 years of age in Nyanza Province, Kenya. Rates were extrapolated nationally with use of province-specific data on diarrheal illness. Direct medical costs were estimated using record review and World Health Organization estimates. Household costs were collected through parental interviews. The impact of vaccination on health burden and on the cost-effectiveness per disability-adjusted life-year and lives saved were calculated.
Annually in Kenya, rotavirus infection causes 19% of hospitalizations and 16% of clinic visits for diarrhea among children <5 years of age and causes 4471 deaths, 8781 hospitalizations, and 1,443,883 clinic visits. Nationally, rotavirus disease costs the health care system $10.8 million annually. Routine vaccination with a 2-dose rotavirus vaccination series would avert 2467 deaths (55%), 5724 hospitalizations (65%), and 852,589 clinic visits (59%) and would save 58 disability-adjusted life-years per 1000 children annually. At $3 per series, a program would cost $2.1 million in medical costs annually; the break-even price is $2.07 per series.
A rotavirus vaccination program would reduce the substantial burden of rotavirus disease and the economic burden in Kenya.
轮状病毒疫苗接种的预期影响和成本效益对于在非洲引入轮状病毒疫苗至关重要，因为非洲的卫生干预资金有限。
利用医院记录、卫生服务利用调查、口头尸检数据以及腹泻病监测数据，确定肯尼亚尼扬扎省5岁以下儿童因轮状病毒导致的腹泻住院率、门诊就诊率和死亡率。利用该省腹泻病的特定数据推算全国发病率。通过病历审查和世界卫生组织的估计来估算直接医疗费用。通过对家长的访谈收集家庭成本。计算了疫苗接种对健康负担以及每残疾调整生命年和挽救生命的成本效益的影响。
在肯尼亚，轮状病毒感染每年导致5岁以下儿童腹泻住院病例的19%和门诊就诊病例的16%，并导致4471例死亡、8781例住院和1443883例门诊就诊。在全国范围内，轮状病毒疾病每年给医疗系统造成1080万美元的损失。采用2剂轮状病毒疫苗常规接种系列可避免2467例死亡（55%）、5724例住院（65%）和852589例门诊就诊（59%），每年每1000名儿童可挽救58个残疾调整生命年。每剂疫苗3美元，该项目每年的医疗成本为210万美元；盈亏平衡价格为每剂2.07美元。
轮状病毒疫苗接种项目将减轻肯尼亚轮状病毒疾病的沉重负担和经济负担。
