Javanbakht Mehdi, Moradi-Lakeh Maziar, Yaghoubi Mohsen, Esteghamati Abdoulreza, Mansour Ghanaie Roxana, Mahmoudi Sussan, Shamshiri Ahmad-Reza, Zahraei Seyed Mohsen, Baxter Louise, Shakerian Sareh, Chaudhri Irtaza, Fleming Jessica A, Munier Aline, Baradaran Hamid R
Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Vaccine. 2015 May 7;33 Suppl 1:A192-200. doi: 10.1016/j.vaccine.2014.12.035.
Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society.
The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results.
Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario.
Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
尽管伊朗腹泻病死亡率已大幅下降，但在5岁以下儿童的疾病负担中仍占重要比例。轮状病毒疫苗是特定流行病学条件下预防腹泻病最有效的策略之一。本研究旨在从伊朗卫生系统和社会的角度评估引入轮状病毒疫苗（3剂五价Rotateq（RV5））的成本效益。
使用TRIVAC决策支持模型计算由于疫苗接种计划产生的总增量成本、获得的生命年（LYs）以及避免的伤残调整生命年（DALYs）。必要的输入数据从最有效的可获取来源以及对流行病学研究的系统评价和荟萃分析中收集。我们使用世界卫生组织指南来估计疫苗接种成本。健康收益和成本均考虑3%的年度贴现率。进行确定性敏感性分析以检验模型结果的稳健性。
我们的结果表明，10年内因轮状病毒腹泻可能损失的总DALYs为138,161，其中76,591可通过轮状病毒疫苗预防。10个队列的总疫苗接种成本估计为4.9991亿美元。此外，由于预防门诊和住院，将节省4.7061亿美元（从社会角度节省成本）。我们估计RV5疫苗接种每避免一个DALY的成本为2868美元，从政府角度来看，这对应于一种高成本效益策略。在敏感性分析中，除了最不利的情况以及低疫苗效力和疾病发病率情况外，从社会角度测试的所有情景仍然具有成本节约或高成本效益。
基于这些发现，从政府角度来看，引入轮状病毒疫苗是一种高成本效益策略。将该疫苗引入国家免疫规划是有效利用可用资金以降低伊朗儿童死亡率和发病率的举措。
