Mousavi Jarrahi Yasaman, Zahraei Seyed Mohsen, Sadigh Nader, Esmaeelpoor Langeroudy Keyhan, Khodadost Mahmoud, Ranjbaran Mehdi, Sanjari Moghaddam Ali, Besharat Mehdi, Mosavi Jarrahi Alireza
a Aging Research Center, Sabzevar University of Medical Sciences , Sabzevar , Iran.
b Center for Communicable Disease Control, Ministry of Health and Medical Education , Tehran , Iran.
Hum Vaccin Immunother. 2016 Mar 3;12(3):794-800. doi: 10.1080/21645515.2015.1087626.
Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran.
轮状病毒是导致幼儿住院或因特定疾病死亡的严重腹泻的最常见原因。有效的疫苗最近已获批准，并实施了成功的疫苗接种计划。本研究的目的是评估伊朗大规模轮状病毒疫苗接种计划的成本效益。我们开发了一个马尔可夫模型，该模型反映了轮状病毒自然史的关键特征。模型参数通过实地研究进行评估，或通过文献检索和已发表的数据得出。我们将该模型应用于2009年伊朗出生队列，并评估了将轮状病毒疫苗（Rotarix®）纳入伊朗扩大免疫计划（EPI）的成本效益。估计住院率为0.05，门诊率为每人每年0.23例，用2剂（Rotarix®）为伊朗的1231735名婴儿接种疫苗，在5年的随访期间将预防32092例住院、158750次门诊就诊和1591例死亡。在每疗程疫苗成本为10美元的基础假设下，从医疗保健角度来看，疫苗接种将产生额外成本1,019,192美元，并避免54680个伤残调整生命年（DALY）。从社会角度来看，在避免相同数量DALY的情况下，社会将节省15,192,568美元。增量成本效益比显示，从医疗保健角度来看，每避免一个DALY的成本为19美元，从社会角度来看，每避免一个DALY节省278美元。将轮状病毒疫苗引入EPI计划将是伊朗一项极具成本效益的公共卫生干预措施。
