School of Public Health, Mongolian National University of Medical Science, Rm. 334, Sukhbaatar District, S. Zorig Street, Ulaanbaatar, Mongolia.
PATH, Rue de Varembé 7, 1202 Geneva, Switzerland.
Vaccine. 2019 Feb 4;37(6):798-807. doi: 10.1016/j.vaccine.2018.12.056. Epub 2019 Jan 11.
Rotavirus disease in Mongolia is estimated to cause more than 50 deaths yearly and many more cases and hospitalizations. Mongolia must self-finance new vaccines and does not automatically access Gavi prices for vaccines. Given the country's limited resources for health, it is critical to assess potential new vaccine programs. This evaluation estimates the impact, cost-effectiveness, and budget implications associated with a nationwide rotavirus vaccine introduction targeting infants as part of the national immunization program in Mongolia, in order to inform decision-making around introduction.
The analysis examines the use of the two-dose vaccine ROTARIX®, and three-dose vaccines ROTAVAC® and RotaTeq® compared to no vaccination from the government and the societal perspective. We use a modelling approach informed by local data and published literature to analyze the impact and cost-effectiveness of rotavirus vaccination over a ten-year time period starting in 2019, using a 3% discount rate. Our main outcome measure is the incremental cost-effectiveness ratio (ICER) expressed as US dollar per DALY averted. We assessed uncertainty around a series of parameters through univariate sensitivity analysis.
Rotavirus vaccination in Mongolia could avert more than 95,000 rotavirus cases and 271 deaths, over 10 years. Averted visits and hospitalizations represent US$2.4 million in health care costs saved by the government. The vaccination program cost ranges from $6 to $11 million depending on vaccine choice. From the governmental perspective, ICER ranged from $412 to $1050 and from $77 to $715 when considering the societal perspective. Sensitivity analysis highlights vaccine price as the main driver of uncertainty.
Introduction of rotavirus vaccination is likely to be highly cost-effective in Mongolia, with ICERs estimated at only a fraction of Mongolia's per capita GDP. From an economic standpoint, ROTAVAC® is the least costly and most cost-effective product choice.
据估计，蒙古每年因轮状病毒疾病导致的死亡人数超过 50 人，还有更多病例和住院病例。蒙古必须自行出资购买新疫苗，且不能自动获得疫苗全球联盟提供的疫苗价格。鉴于该国卫生资源有限，因此评估潜在的新疫苗计划至关重要。本评估旨在为蒙古国家免疫规划引入全国性轮状病毒疫苗提供决策依据，估计了针对蒙古婴儿的全国性轮状病毒疫苗接种计划的影响、成本效益和预算影响，以便为决策提供信息。
该分析从政府和社会角度比较了使用两剂疫苗 ROTARIX®和三剂疫苗 ROTAVAC®和 RotaTeq®与不接种疫苗的情况。我们使用基于当地数据和已发表文献的建模方法，在 2019 年开始的十年期间分析轮状病毒疫苗接种的影响和成本效益，使用 3%的贴现率。我们的主要结果衡量标准是增量成本效益比（ICER），以每例 DALY 节省的美元表示。我们通过单变量敏感性分析评估了一系列参数的不确定性。
在蒙古，轮状病毒疫苗接种可在 10 年内避免超过 95000 例轮状病毒病例和 271 例死亡。避免的就诊和住院治疗为政府节省了 240 万美元的医疗保健费用。疫苗接种计划的成本范围取决于疫苗选择，从 600 万美元到 1100 万美元不等。从政府的角度来看，ICER 范围从 412 美元到 1050 美元不等，从社会角度来看，ICER 范围从 77 美元到 715 美元不等。敏感性分析强调了疫苗价格是不确定性的主要驱动因素。
在蒙古，轮状病毒疫苗接种极有可能具有成本效益，其 ICER 估计仅为蒙古人均 GDP 的一小部分。从经济角度来看，ROTAVAC®是成本最低、最具成本效益的产品选择。
