Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Vaccine. 2013 Jul 11;31(32):3300-7. doi: 10.1016/j.vaccine.2013.04.055. Epub 2013 May 21.
This study aims to assess the cost-effectiveness of rotavirus immunization in Indonesia, taking breastfeeding patterns explicitly into account.
An age-structured cohort model was developed for the 2011 Indonesia birth cohort. Next, we compared two strategies, the current situation without rotavirus immunization versus the alternative of a national immunization program. The model applies a 5 year time horizon, with 1 monthly analytical cycles for children less than 1 year of age and annually thereafter. Three scenarios were compared to the base case reflecting the actual distribution over the different breastfeeding modes as present in Indonesia; i.e., the population under 2 years old with (i) 100% exclusive breastfeeding, (ii) 100% partial breastfeeding and (iii) 100% no breastfeeding. Monte Carlo simulations were used to examine the economic acceptability and affordability of the rotavirus vaccination.
Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of life of a child. Under the market vaccine price the total yearly vaccine cost would amount to US$ 65 million. The incremental cost per quality-adjusted-life-year (QALY) in the base case was US$ 174 from the societal perspective. Obviously, it was much lower than the 2011 Indonesian Gross Domestic Product (GDP) per capita of US$ 3495. Affordability results showed that at the Global Alliance for Vaccines and Immunization (GAVI)-subsidized vaccine price, rotavirus vaccination could be affordable for the Indonesian health system. Increased uptake of breastfeeding might slightly reduce cost-effectiveness results.
Rotavirus immunization in Indonesia would be a highly cost-effective health intervention even under the market vaccine price. The results illustrate that rotavirus immunization would greatly reduce the burden of disease due to rotavirus infection. Even within increased uptake of breastfeeding, cost-effectiveness remains favorable.
本研究旨在评估轮状病毒免疫接种在印度尼西亚的成本效益，明确考虑到母乳喂养模式。
为 2011 年印度尼西亚出生队列建立了一个年龄结构队列模型。接下来，我们比较了两种策略，即目前没有轮状病毒免疫接种的情况和国家免疫规划的替代方案。该模型采用 5 年时间框架，1 岁以下儿童每月进行 1 次分析周期，之后每年进行 1 次。为了反映印度尼西亚目前存在的不同母乳喂养模式的实际分布情况，我们比较了三种方案与基本情况，即 2 岁以下人群的（i）100%纯母乳喂养、（ii）100%部分母乳喂养和（iii）100%无母乳喂养。蒙特卡罗模拟用于检查轮状病毒疫苗接种的经济可接受性和负担能力。
轮状病毒免疫接种可有效减少儿童生命前 5 年的轮状病毒严重病例。在市场疫苗价格下，每年的疫苗总成本将达到 6500 万美元。从社会角度看，基本情况下每增加一个质量调整生命年（QALY）的增量成本为 174 美元。显然，这远低于 2011 年印度尼西亚人均国内生产总值（GDP）3495 美元。负担能力结果表明，在全球疫苗和免疫联盟（GAVI）补贴后的疫苗价格下，轮状病毒疫苗接种对印度尼西亚卫生系统是负担得起的。母乳喂养率的提高可能会略微降低成本效益结果。
即使在市场疫苗价格下，印度尼西亚的轮状病毒免疫接种也是一种具有高度成本效益的卫生干预措施。结果表明，轮状病毒免疫接种将大大减轻轮状病毒感染引起的疾病负担。即使在母乳喂养率提高的情况下，成本效益仍然是有利的。
