ABSTRACT
Purpose: To support future rotavirus vaccination evaluation by Health Technology Assessment Agencies, this systematic review presents synthesized findings reported in cost-effectiveness studies in high-income settings based on dynamic transmission modeling.
Methods: We searched CEA Registry, MEDLINE, Embase, Health Technology Assessment Database, Scopus, and the National Health Service Economic Evaluation Database for studies published since 2002. Full economic evaluations studies based on dynamic transmission models, focusing on high-income countries, live oral rotavirus vaccine and children ≤ 5 years of age were eligible for inclusion. Included studies were appraised for quality and risk of bias using the Consensus on Health Economic Criteria (CHEC) list and the Philips checklist. The review protocol was prospectively registered with PROSPERO (CRD42020208406).
Results: A total of four economic evaluations were identified. Study settings included England and Wales, France, Norway, and the United States. All studies compared either pentavalent or monovalent rotavirus vaccines to no intervention; all were cost-utility analyses that reported incremental cost per QALY gained, and consistently concluded that rotavirus vaccination is cost-effective compared with no vaccination relative to the respective country willingness to pay thresholds in high-income countries when the modeling assessment framework takes into account herd protection benefits (Table 1).
Conclusions: Rotavirus vaccination was found to be cost-effective in all identified studies that used dynamic transmission models in high-income settings, where child fatality rate due to rotavirus gastroenteritis is close to zero. Previous systematic reviews [1,2] of economic evaluations took into account mostly static and a few dynamic transmission models and have less conclusive finding about the rotavirus vaccination results than the current study. We hypothesize that that choice of modeling techniques could have significantly influenced cost-effectiveness evaluation results for rotavirus vaccination. Further research is underway to substantiate this hypothesis.