Diop Abdou, Atherly Deborah, Faye Alioune, Lamine Sall Farba, Clark Andrew D, Nadiel Leon, Yade Binetou, Ndiaye Mamadou, Fafa Cissé Moussa, Ba Mamadou
Independent Consultant for PATH, Dakar, Senegal.
PATH, Seattle, WA, United States.
Vaccine. 2015 May 7;33 Suppl 1:A119-25. doi: 10.1016/j.vaccine.2014.12.065.
Rotavirus is the leading cause of acute severe diarrhea among children under 5 globally and one of the leading causes of death attributable to diarrhea. Among African children hospitalized with diarrhea, 38% of the cases are due to rotavirus. In Senegal, rotavirus deaths are estimated to represent 5.4% of all deaths among children under 5. Along with the substantial disease burden, there is a growing awareness of the economic burden created by diarrheal disease. This analysis aims to provide policymakers with more consistent and reliable economic evidence to support the decision-making process about the introduction and maintenance of a rotavirus vaccine program.
The study was conducted using the processes and tools first established by the Pan American Health Organization's ProVac Initiative in the Latin American region. TRIVAC version 2.0, an Excel-based model, was used to perform the analysis. The costs and health outcomes were calculated for 20 successive birth cohorts (2014-2033). Model inputs were gathered from local, national, and international sources with the guidance of a Senegalese group of experts including local pediatricians, personnel from the Ministry of Health and the World Health Organization, as well as disease-surveillance and laboratory specialists.
The cost per disability-adjusted life-year (DALY) averted, discounted at 3%, is US$ 92 from the health care provider perspective and US$ 73 from the societal perspective. For the 20 cohorts, the vaccine is projected to prevent more than 2 million cases of rotavirus and to avert more than 8500 deaths. The proportion of rotavirus deaths averted is estimated to be 42%. For 20 cohorts, the discounted net costs of the program were estimated to be US$ 17.6 million from the healthcare provider perspective and US$ 13.8 million from the societal perspective.
From both perspectives, introducing the rotavirus vaccine is highly cost-effective compared to no vaccination. The results are consistent with those found in many African countries. The ProVac process and tools contributed to a collaborative, country-led process in Senegal that provides a platform for gathering and reporting evidence for vaccine decision-making.
轮状病毒是全球5岁以下儿童急性重症腹泻的主要病因，也是腹泻致死的主要原因之一。在因腹泻住院的非洲儿童中，38%的病例由轮状病毒引起。在塞内加尔，估计轮状病毒死亡病例占5岁以下儿童死亡总数的5.4%。除了巨大的疾病负担外，人们也越来越意识到腹泻病造成的经济负担。本分析旨在为政策制定者提供更一致、可靠的经济证据，以支持关于引入和维持轮状病毒疫苗计划的决策过程。
本研究采用泛美卫生组织在拉丁美洲地区的ProVac倡议最初建立的流程和工具进行。使用基于Excel的TRIVAC 2.0模型进行分析。在包括当地儿科医生、卫生部和世界卫生组织人员以及疾病监测和实验室专家在内的塞内加尔专家小组的指导下，从当地、国家和国际来源收集模型输入数据。
从医疗服务提供者的角度来看，每避免一个伤残调整生命年（DALY）的成本，按3%的贴现率计算为92美元；从社会角度来看为73美元。对于这连续的20个队列，预计该疫苗可预防超过200万例轮状病毒病例，并避免超过8500例死亡。估计避免的轮状病毒死亡比例为42%。对于20个队列，从医疗服务提供者的角度来看，该计划的贴现净成本估计为1760万美元，从社会角度来看为1380万美元。
从两个角度来看，与不接种疫苗相比，引入轮状病毒疫苗具有很高的成本效益。结果与许多非洲国家的情况一致。ProVac流程和工具促成了塞内加尔由国家主导的合作过程，为收集和报告疫苗决策证据提供了一个平台。
