Mehdi Javanbakht1, Maziar Moradi-Lakeh2, Mohsen Yaghoubi3, Abdoulreza Esteghamati4, Roxana Mansour Ghanaie5, Sussan Mahmoudi6, Ahmad-Reza Shamshiri7, Seyed Mohsen Zahraei8, Louise Baxter9, Sareh Shakerian10, Irtaza Chaudhri11, Jessica A Fleming12, Aline Munier13, Hamid R Baradaran14. 1. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. Electronic address: m.javanbakht@abdn.ac.uk. 2. Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mmoradi@uw.edu. 3. Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran. Electronic address: mohsenyaq@yahoo.com. 4. Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran. Electronic address: Esteghamati@gmail.com. 5. Pediatric Infections Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: roxanaghanaie@yahoo.com. 6. Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. Electronic address: Sussanmahmoody@yahoo.com. 7. Tehran University of Medical Sciences, Tehran, Iran. Electronic address: ar_shamshiri@yahoo.com. 8. Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran. Electronic address: zahraeicdc@yahoo.com. 9. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: Louise.Baxter@lshtm.ac.uk. 10. School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: sarehshakareian@gmail.com. 11. Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt. Electronic address: CHAUDHRII@emro.who.int. 12. PATH, Seattle, WA, USA. Electronic address: jfleming@path.org. 13. Agence de Médecine Préventive, Paris, France. Electronic address: amunier@aamp.org. 14. Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Center for Nursing Care Research, Iran University of Medical Sciences, Tehran, Iran. Electronic address: baradaran.hr@iums.ac.ir.
Abstract
BACKGROUND: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. METHODS: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. RESULTS: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. CONCLUSION: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
BACKGROUND: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. METHODS: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. RESULTS: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. CONCLUSION: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.
Authors: Ibrahim Khalil; Danny V Colombara; Mohammad Hossein Forouzanfar; Christopher Troeger; Farah Daoud; Maziar Moradi-Lakeh; Charbel El Bcheraoui; Puja C Rao; Ashkan Afshin; Raghid Charara; Kalkidan Hassen Abate; Mohammed Magdy Abd El Razek; Foad Abd-Allah; Remon Abu-Elyazeed; Aliasghar Ahmad Kiadaliri; Ali Shafqat Akanda; Nadia Akseer; Khurshid Alam; Deena Alasfoor; Raghib Ali; Mohammad A AlMazroa; Mahmoud A Alomari; Rajaa Mohammad Salem Al-Raddadi; Ubai Alsharif; Shirina Alsowaidi; Khalid A Altirkawi; Nelson Alvis-Guzman; Walid Ammar; Carl Abelardo T Antonio; Hamid Asayesh; Rana Jawad Asghar; Suleman Atique; Ashish Awasthi; Umar Bacha; Alaa Badawi; Aleksandra Barac; Neeraj Bedi; Tolesa Bekele; Isabela M Bensenor; Balem Demtsu Betsu; Zulfiqar Bhutta; Aref A Bin Abdulhak; Zahid A Butt; Hadi Danawi; Manisha Dubey; Aman Yesuf Endries; Imad D A Faghmous; Talha Farid; Maryam S Farvid; Farshad Farzadfar; Seyed-Mohammad Fereshtehnejad; Florian Fischer; Joseph Robert Anderson Fitchett; Katherine B Gibney; Ibrahim Abdelmageem Mohamed Ginawi; Melkamu Dedefo Gishu; Harish Chander Gugnani; Rahul Gupta; Gessessew Bugssa Hailu; Randah Ribhi Hamadeh; Samer Hamidi; Hilda L Harb; Mohammad T Hedayati; Mohamed Hsairi; Abdullatif Husseini; Nader Jahanmehr; Mehdi Javanbakht; Tariku Jibat; Jost B Jonas; Amir Kasaeian; Yousef Saleh Khader; Abdur Rahman Khan; Ejaz Ahmad Khan; Gulfaraz Khan; Tawfik Ahmed Muthafer Khoja; Yohannes Kinfu; Niranjan Kissoon; Ai Koyanagi; Aparna Lal; Asma Abdul Abdul Latif; Raimundas Lunevicius; Hassan Magdy Abd El Razek; Azeem Majeed; Reza Malekzadeh; Alem Mehari; Alemayehu B Mekonnen; Yohannes Adama Melaku; Ziad A Memish; Walter Mendoza; Awoke Misganaw; Layla Abdalla Ibrahim Mohamed; Jean B Nachega; Quyen Le Nguyen; Muhammad Imran Nisar; Emmanuel Kwame Peprah; James A Platts-Mills; Farshad Pourmalek; Mostafa Qorbani; Anwar Rafay; Vafa Rahimi-Movaghar; Sajjad Ur Rahman; Rajesh Kumar Rai; Saleem M Rana; Chhabi L Ranabhat; Sowmya R Rao; Amany H Refaat; Mark Riddle; Gholamreza Roshandel; George Mugambage Ruhago; Muhammad Muhammad Saleh; Juan R Sanabria; Monika Sawhney; Sadaf G Sepanlou; Tesfaye Setegn; Karen Sliwa; Chandrashekhar T Sreeramareddy; Bryan L Sykes; Mohammad Tavakkoli; Bemnet Amare Tedla; Abdullah S Terkawi; Kingsley Ukwaja; Olalekan A Uthman; Ronny Westerman; Mamo Wubshet; Muluken A Yenesew; Naohiro Yonemoto; Mustafa Z Younis; Zoubida Zaidi; Maysaa El Sayed Zaki; Abdullah A Al Rabeeah; Haidong Wang; Mohsen Naghavi; Theo Vos; Alan D Lopez; Christopher J L Murray; Ali H Mokdad Journal: Am J Trop Med Hyg Date: 2016-10-10 Impact factor: 2.345
Authors: Barbara Jauregui; Ana Gabriela Felix Garcia; Cara Bess Janusz; Julia Blau; Aline Munier; Deborah Atherly; Mercy Mvundura; Rana Hajjeh; Benjamin Lopman; Andrew David Clark; Louise Baxter; Raymond Hutubessy; Ciro de Quadros; Jon Kim Andrus Journal: Vaccine Date: 2015-05-07 Impact factor: 3.641