Essential Medicines and Technology Division, Department of Medical Services, Ministry of Health, Bhutan.
Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health (MoPH), Thailand.
Vaccine. 2020 Jul 6;38(32):5049-5059. doi: 10.1016/j.vaccine.2020.05.035. Epub 2020 Jun 7.
Diarrhoea remains one of the top ten causes of under-five child morbidity in Bhutan, and rotavirus is a significant cause of child diarrhoeal hospitalisations. This study sought to determine the health outcomes, cost-effectiveness, and budget and human resource implications of introducing rotavirus vaccines in the routine immunisation program to inform Bhutan's decision-making process.
We used UNIVAC model (version 1.3.41) to evaluate the cost-effectiveness of a rotavirus vaccination programme compared with no vaccination from a government perspective. We also projected the impact of rotavirus vaccination on human resources and budget. Acost-effectiveness threshold was determined to be 0.5 times the gross domestic product (GDP) per capita (equivalent to the United States dollar ($) 1,537) per Disability-Adjusted Life-Year (DALY) averted.One-way deterministic and probabilistic sensitivity analyses, and threshold analyses were performed to capture parameter uncertainties.
In Bhutan, a rotavirus vaccination programme over 10 years (2020 to 2029) can avert between 104 and 115 DALYs, at an incremental cost ranging from $322,000 to $1,332,000. The incremental cost-effectiveness ratio (ICER) across four vaccination programmes compared to no vaccination scenario were $9,267, $11,606, $3,201, and $2,803 per DALY averted for ROTARIX, RotaTeq, ROTAVAC, and ROTASIIL, respectively. The net five-year budget impact of introducing a rotavirus vaccination programme ranged from $0.20 to $0.81 million. The rotavirus vaccination programme has a potential to reduce the workload of health care workers such as paediatricians, nurses, dieticians, and pharmacists; however, the programme would require an additional 1.93-2.88 full-time equivalent of health assistants.
At the current cost-effectiveness threshold, routine rotavirus vaccination in Bhutan is unlikely to be cost-effective with any of the currently available vaccines. However, routine vaccination with ROTASIIL was under the cost-effectiveness threshold of one times the GDP per capita ($3,074). ROTASIIL and ROTAVAC would provide the best value for money in Bhutan.
腹泻仍然是不丹五岁以下儿童发病的十大原因之一，轮状病毒是儿童腹泻住院的重要原因。本研究旨在确定在常规免疫规划中引入轮状病毒疫苗的健康结果、成本效益以及对人力资源和预算的影响，以为不丹的决策过程提供信息。
我们使用 UNIVAC 模型（版本 1.3.41）从政府角度评估了轮状病毒疫苗接种计划与不接种疫苗相比的成本效益。我们还预测了轮状病毒疫苗接种对人力资源和预算的影响。成本效益阈值确定为每避免一个残疾调整生命年（DALY） 0.5 倍人均国内生产总值（GDP）（相当于美元 1537 美元）。进行了单向确定性和概率敏感性分析以及阈值分析，以捕捉参数不确定性。
在不丹，2020 年至 2029 年十年期间实施轮状病毒疫苗接种计划可避免 104 至 115 个 DALY，增量成本为 322,000 美元至 1332,000 美元。与不接种疫苗相比，四种疫苗接种方案的增量成本效益比（ICER）分别为 ROTARIX、RotaTeq、ROTAVAC 和 ROTASIIL 每避免一个 DALY 分别为 9267 美元、11606 美元、3201 美元和 2803 美元。引入轮状病毒疫苗接种计划的五年净预算影响范围为 20 万至 81 万美元。轮状病毒疫苗接种计划有可能减轻儿科医生、护士、营养师和药剂师等医护人员的工作量；然而，该计划需要额外的 1.93-2.88 个全职等效的卫生助理。
根据当前的成本效益阈值，使用任何现有疫苗在不丹进行常规轮状病毒疫苗接种不太可能具有成本效益。然而，常规接种 ROTASIIL 的成本效益低于人均 GDP 的一倍（3074 美元）。ROTASIIL 和 ROTAVAC 将为不丹提供最佳的性价比。
