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Cost-Effectiveness of Rotavirus Vaccination: Exploring Caregiver(s) and ``No Medical Care'' Disease Impact in Belgium

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  • Joke Bilcke

    (Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium, Joke.Bilcke@ua.ac.be)

  • Pierre Van Damme

    (Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium)

  • Philippe Beutels

    (Centre for Health Economics & Modelling Infectious Diseases, Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium, School of Public Health, University of Sydney, Australia)

Abstract

Aim . To estimate the cost-effectiveness of universal childhood rotavirus vaccination in Belgium, taking into account the impact of caregiver burden and the burden of sick children for whom no medical care is sought (``no medical care''). Methods . A cohort of newborns is modeled in relation to costs and health outcomes for rotavirus disease, distinguishing episodes leading to consultations, hospitalizations, and deaths from no medical care episodes. Fully funded universal vaccination is compared with no vaccination as well as with the current situation in Belgium, whereby the 2-dose Rotarix or the 3-dose RotaTeq vaccine can be bought at market prices, which are partially reimbursed. Results . Compared with no vaccination, fully funded universal rotavirus vaccination would cost 51,030 per quality-adjusted life year (QALY) gained with Rotarix and 65,767 with RotaTeq (for society, 7572 and 30,227 per QALY, respectively). However, there is considerable uncertainty due to some analytical choices: the proportion of simulations with an acceptable incremental cost-effectiveness ratio (given a willingness to pay 50,000 for an additional QALY), increases from 2%/0.6% (Rotarix/RotaTeq) to 86%/59% when considering no medical care, and including 2 caregivers to estimate QALY loss instead of zero. Uncertainty is greater still under the societal than under the health care payer perspective. Conclusion . For the Belgian health care payer, at current vaccine prices, universal childhood rotavirus vaccination is unlikely to be judged cost-effective versus no vaccination but would be a more efficient and equitable choice than continuing with current practice.

Suggested Citation

  • Joke Bilcke & Pierre Van Damme & Philippe Beutels, 2009. "Cost-Effectiveness of Rotavirus Vaccination: Exploring Caregiver(s) and ``No Medical Care'' Disease Impact in Belgium," Medical Decision Making, , vol. 29(1), pages 33-50, January.
    • Handle: RePEc:sae:medema:v:29:y:2009:i:1:p:33-50
    DOI: 10.1177/0272989X08324955
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    References listed on IDEAS

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    1. Werner B. F. Brouwer & Marc A. Koopmanschap & Frans F. H. Rutten, 1997. "Productivity Costs Measurement Through Quality of Life? A Response to the Recommendation of the Washington Panel," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 253-259, May.
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    Cited by:

    1. Hareth Al‐Janabi & Job Van Exel & Werner Brouwer & Caroline Trotter & Linda Glennie & Laurie Hannigan & Joanna Coast, 2016. "Measuring Health Spillovers for Economic Evaluation: A Case Study in Meningitis," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1529-1544, December.
    2. Stefanie Knoll & Christoph Mair & Ursula Benter & Katja Vouk & Baudouin Standaert, 2013. "Will vaccination against rotavirus infection with RIX4414 be cost-saving in Germany?," Health Economics Review, Springer, vol. 3(1), pages 1-11, December.
    3. Hareth Al-Janabi & Terry Flynn & Joanna Coast, 2011. "QALYs and Carers," PharmacoEconomics, Springer, vol. 29(12), pages 1015-1023, December.
    4. Hareth Al-Janabi & Andrea Manca & Joanna Coast, 2017. "Predicting carer health effects for use in economic evaluation," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-18, September.
    5. Marisa Holubar & Maria Christina Stavroulakis & Yvonne Maldonado & John P A Ioannidis & Despina Contopoulos-Ioannidis, 2017. "Impact of vaccine herd-protection effects in cost-effectiveness analyses of childhood vaccinations. A quantitative comparative analysis," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-22, March.
    6. Joke Bilcke & Pierre Van Damme & Marc Van Ranst & Niel Hens & Marc Aerts & Philippe Beutels, 2009. "Estimating the Incidence of Symptomatic Rotavirus Infections: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-10, June.

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