Center for Vaccine Innovation and Access, PATH, Geneva, Switzerland.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2021 Jul;9(7):e942-e956. doi: 10.1016/S2214-109X(21)00167-4. Epub 2021 Apr 20.
Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccine Alliance, have been slow to adopt rotavirus vaccines. Few studies have evaluated the cost-effectiveness and benefit-risk of rotavirus vaccination in these settings. We aimed to assess the potential economic and health impact of rotavirus vaccination in 63 MICs not eligible for funding from Gavi.
In this modelling study, we estimated the cost-effectiveness and benefit-risk of rotavirus vaccination in 63 MICs not eligible to Gavi funding. We used an Excel-based proportionate outcomes model with a finely disaggregated age structure to estimate the number of rotavirus gastroenteritis cases, clinic visits, hospitalisations, and deaths averted by vaccination in children younger than 5 years over a 10-year period. We calculated cost-effectiveness ratios (costs per disability-adjusted life-years averted compared with no vaccination) and benefit-risk ratios (number of hospitalisations due to rotavirus gastroenteritis averted per excess hospitalisations due to intussusception). We evaluated three alternative vaccines available globally (Rotarix, Rotavac, and Rotasiil) and used information from vaccine manufacturers regarding anticipated vaccine prices. We ran deterministic and probabilistic uncertainty analyses.
Over the period 2020-29, rotavirus vaccines could avert 77 million (95% uncertainty interval [UI] 51-103) cases of rotavirus gastroenteritis and 21 million (12-36) clinic visits, 3 million (1·4-5·6) hospitalisations, and 37 900 (25 900-55 900) deaths due to rotavirus gastroenteritis in 63 MICs not eligible for Gavi support. From a government perspective, rotavirus vaccination would be cost-effective in 48 (77%) of 62 MICs considered. The benefit-risk ratio for hospitalisations prevented versus those potentially caused by vaccination exceeded 250:1 in all countries.
In most MICs not eligible for Gavi funding, rotavirus vaccination has high probability to be cost-effective with a favourable benefit-risk profile. Policy makers should consider this new evidence when making or revisiting decisions on the use of rotavirus vaccines in their respective countries.
Bill & Melinda Gates Foundation.
不符合全球疫苗免疫联盟（Gavi）资助条件的中等收入国家（MIC）推出轮状病毒疫苗的速度较为缓慢。鲜有研究评估轮状病毒疫苗在这些国家的成本效益和收益风险。我们旨在评估轮状病毒疫苗在 63 个不符合 Gavi 资助条件的 MIC 中的潜在经济和健康影响。
在本建模研究中，我们对 63 个不符合 Gavi 资助条件的 MIC 轮状病毒疫苗接种的成本效益和收益风险进行了估计。我们使用基于 Excel 的比例结果模型，采用精细的年龄结构细分，以估计在 10 年内 5 岁以下儿童因轮状病毒肠胃炎而避免的病例数、门诊就诊数、住院数和死亡数。我们计算了成本效益比（与不接种疫苗相比，每避免一个残疾调整生命年的成本）和收益风险比（因轮状病毒肠胃炎而避免的住院人数与因肠套叠而导致的超额住院人数之比）。我们评估了三种全球可用的替代疫苗（Rotarix、Rotavac 和 Rotasiil），并使用疫苗制造商提供的有关预期疫苗价格的信息。我们进行了确定性和概率性不确定性分析。
在 2020 年至 2029 年期间，轮状病毒疫苗可以避免 7700 万（95%不确定区间[UI] 5100 万至 1.03 亿）例轮状病毒肠胃炎病例和 2100 万（1200 万至 3600 万）例门诊就诊、300 万（140 万至 560 万）例住院和 37900（25900 至 55900）例因轮状病毒肠胃炎导致的死亡。从政府的角度来看，轮状病毒疫苗接种在 62 个被认为符合条件的 MIC 中的 48 个（77%）具有成本效益。在所有国家，预防住院的收益风险比超过了 250:1。
在大多数不符合 Gavi 资助条件的 MIC 中，轮状病毒疫苗接种具有高成本效益和有利的收益风险特征。决策者在做出或重新考虑各自国家使用轮状病毒疫苗的决策时，应考虑这一新证据。
比尔和梅琳达·盖茨基金会。
