Department of Sustainable Development, Appalachian State University, ASU Box 32080, Boone, NC 28608, USA.
Department of Sustainable Development, Appalachian State University, ASU Box 32080, Boone, NC 28608, USA.
Vaccine. 2018 Dec 14;36(51):7868-7877. doi: 10.1016/j.vaccine.2018.02.009. Epub 2018 Jul 11.
Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, many low- and middle-income countries have introduced rotavirus vaccine, resulting in documented reductions in hospitalizations and child mortality. We examined the potential impact and cost-effectiveness of introducing rotavirus vaccination in Lao People's Democratic Republic using an Excel-based spreadsheet model. We estimated mortality risk factors, patterns of care seeking, and vaccination access to predict outcomes for regional, provincial, and socioeconomic subpopulations for one birth cohort through their first five years of life and life course in Disability-Adjusted Life Years estimates. Socioeconomic status was defined by categorizing households into regional wealth quintiles based on a national asset index. We modeled a two-dose ROTARIX vaccine under current Gavi pricing and efficacy estimates from Bangladesh and Vietnam. DPT1 and DPT2 coverages were used to estimate rotavirus vaccination coverage. Probabilistic sensitivity analysis was used to assess the impact of uncertainty on model parameters on predicted incremental cost-effectiveness ratios (ICERs), including scenarios of increases in vaccination coverage. Rotavirus vaccination would prevent 143 child deaths/year, or 28% of annual rotavirus burden. The estimated national level ICER for rotavirus vaccination was $140/DALY, with regional socioeconomic subpopulation estimates ranging from $72/DALY for the poorest in the Central region to $353/DALY for the richest in the North region, indicating high cost-effectiveness. Within regions, ICERs are most favorable for children in the poorer and poorest quintiles. However, the full benefits of rotavirus vaccination will only be realized by reducing disparities in vaccination coverage, access to treatment, and environmental health. Improving vaccination coverage to equitable levels alone would prevent 87 additional child deaths per year.
轮状病毒肠炎在 2015 年导致全球近 20 万儿童死亡。在全球范围内，许多低收入和中等收入国家已经引入了轮状病毒疫苗，这导致住院和儿童死亡率的记录下降。我们使用基于 Excel 的电子表格模型来检查在老挝人民民主共和国引入轮状病毒疫苗接种的潜在影响和成本效益。我们估计了死亡率风险因素、寻求治疗的模式和疫苗接种的可及性，以预测一个出生队列在其五岁前和生命过程中的区域、省和社会经济亚人群的结果，使用残疾调整生命年估计数。社会经济地位是通过根据国家资产指数将家庭分为五个区域财富五分位数来定义的。我们根据孟加拉国和越南的当前 Gavi 定价和功效估计值，对两剂 ROTARIX 疫苗进行了建模。DPT1 和 DPT2 的覆盖率用于估计轮状病毒疫苗的覆盖率。概率敏感性分析用于评估模型参数不确定性对预测增量成本效益比 (ICER) 的影响，包括提高疫苗覆盖率的情景。轮状病毒疫苗接种将预防每年 143 例儿童死亡，占轮状病毒负担的 28%。轮状病毒疫苗接种的全国估计 ICER 为 140 美元/残疾调整生命年，区域社会经济亚人群的估计值从中部地区最贫穷地区的 72 美元/残疾调整生命年到北部地区最富裕地区的 353 美元/残疾调整生命年不等，表明成本效益高。在各地区内，对较贫穷和最贫穷五分位数的儿童而言，ICER 最为有利。然而，只有通过减少疫苗接种覆盖率、获得治疗和环境卫生方面的差异，才能充分实现轮状病毒疫苗接种的好处。仅提高疫苗接种覆盖率到公平水平，每年就可预防 87 例额外儿童死亡。
