Sigei Charles, Odaga John, Mvundura Mercy, Madrid Yvette, Clark Andrew David
P.O. Box 293-20203, Londiani, Kenya.
Uganda Martyrs University, Nkozi, P.O., Box 5498, Kampala, Uganda; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Vaccine. 2015 May 7;33 Suppl 1:A109-18. doi: 10.1016/j.vaccine.2014.12.079.
Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda.
In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda.
Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective).
Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national capacity to undertake economic evaluations.
轮状病毒疫苗有潜力预防大量非洲幼儿面临的危及生命的肠胃炎。本文展示了在肯尼亚和乌干达引入轮状病毒疫苗的前瞻性成本效益分析结果。
在每个国家，一名国家顾问与一个国家技术工作组合作，以确定合适的数据并验证研究结果。利用关于人口统计学、疾病负担、卫生服务利用和成本的二手数据来填充TRIVAC成本效益模型。基线分析假设初始疫苗价格为每剂0.20美元，这与疫苗免疫全球联盟规定的低收入国家自付费用相对应。从两国政府的角度以及乌干达社会的角度，对连续20个出生队列评估了2剂次轮状病毒疫苗接种方案的增量成本效益。
在2014年至2033年期间，轮状病毒疫苗接种在肯尼亚可分别避免约60,935例和216,454例5岁以下儿童未贴现的死亡和住院。在乌干达，在2016年至2035年期间，分别避免的未贴现死亡和住院病例数为70,236例和329,779例。在20年期间，肯尼亚贴现后的疫苗计划成本约为8000万美元，乌干达为6000万美元。肯尼亚避免的贴现后政府卫生服务成本为3000万美元，乌干达为1000万美元（包括家庭成本则为1800万美元）。从政府角度看，肯尼亚每避免一个伤残调整生命年（DALY）的成本为38美元，乌干达为34美元（从社会角度为29美元）。
在一系列合理的“假设”情景中，在两国引入轮状病毒疫苗都具有很高的成本效益。国家专家的参与提高了所使用数据的质量，可能会增加结果在决策中的可接受性，并有助于加强国家进行经济评估的能力。
