GSK, Value Evidence and Outcomes, Emerging Markets, GSK Vaccines, Wavre, Belgium.
Center for Enteric Diseases, National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, South Africa.
Clin Drug Investig. 2023 Nov;43(11):851-863. doi: 10.1007/s40261-023-01312-4. Epub 2023 Oct 13.
Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme.
Cost and cost-effectiveness analyses were conducted to compare three rotavirus vaccines using a static, deterministic, population model in children aged <5 years in South Africa from country payer and societal perspectives. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs.
The human rotavirus, live, attenuated, oral vaccine (HRV) was associated with cost savings versus HBRV from both perspectives, and versus BRV-PV 1-dose vial from the societal perspective. In the cost-effectiveness analysis, HRV was estimated to avoid 1,107 home care rotavirus gastroenteritis (RVGE) events, 247 medical visits, 35 hospitalisations, and 4 RVGE-related deaths versus HBRV and BRV-PV. This translated to 73 quality-adjusted life years gained. HRV was associated with lower costs versus HBRV from both payer (-$3.9M) and societal (-$11.5M) perspectives and versus BRV-PV 1-dose vial from the societal perspective (-$3.8M), dominating those options. HRV was associated with higher costs versus BRV-PV 1-dose vial from the payer perspective and versus BRV-PV 2‑dose vial from both payer and societal perspectives (ICERs: $51,834, $121,171, and $16,717, respectively), exceeding the assumed cost-effectiveness threshold of 0.5 GDP per capita.
Vaccination with a 2-dose schedule of HRV may lead to better health outcomes for children in South Africa compared with the 3-dose schedule rotavirus vaccines.
中低收入国家有关轮状病毒疫苗的经济学价值的证据有限。本研究旨在对三种疫苗（人轮状病毒活疫苗，减毒口服疫苗[HRV，2 剂]；轮状病毒疫苗，活，口服，五价[HBRV，3 剂]和轮状病毒疫苗，活减毒口服，冻干[BRV-PV，3 剂]以单剂和双剂小瓶形式呈现）在南非国家免疫规划中的实施情况进行建模。
从国家支付方和社会角度，使用静态、确定性、人群模型对南非<5 岁儿童的三种轮状病毒疫苗进行成本效益分析。采用确定性和概率敏感性分析来评估模型输入不确定性的影响。
从国家支付方和社会角度来看，人轮状病毒活疫苗，减毒口服疫苗（HRV）与 HBRV 相比具有成本节约，与 BRV-PV 单剂小瓶相比具有成本节约。在成本效益分析中，HRV 估计可避免 HBRV 和 BRV-PV 发生 1107 例家庭护理轮状病毒胃肠炎（RVGE）事件、247 例医疗就诊、35 例住院和 4 例 RVGE 相关死亡。这相当于获得了 73 个质量调整生命年。与 HBRV 相比，HRV 从国家支付方（-390 万美元）和社会（-1150 万美元）两个角度都降低了成本，与 BRV-PV 单剂小瓶相比从社会角度降低了成本（-380 万美元），均优于这两个选项。与 BRV-PV 单剂小瓶相比，HRV 从支付方角度来看增加了成本，与 BRV-PV 双剂小瓶相比，从支付方和社会两个角度来看增加了成本（ICER：分别为 51834 美元、121171 美元和 16717 美元），超过了 0.5 个 GDP 人均的假设成本效益阈值。
与三剂轮状病毒疫苗相比，南非儿童接种 2 剂 HRV 疫苗可能会带来更好的健康结果。
