Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Virginia Pitzer

Abstract

INTRODUCTION: Rotavirus is the leading cause of severe gastroenteritis worldwide. Due to the morbidity and mortality of the disease, introduction of rotavirus vaccination in routine childhood immunization programs is recommended for all nations by the World Health Organization.

OBJECTIVE: The primary objective of this study was to assess the cost-effectiveness of rotavirus vaccine introduction in Bangladesh from 2015 to 2024.

METHODS: We used a compartmental SIRS-like model developed by Pitzer et al (2009) to simulate health outcomes due to rotavirus infection in Bangladesh under two scenarios: 92% vaccination coverage and no vaccination (Pitzer et al., 2009). The model was first fitted to data on age-specific rotavirus hospitalizations at the International Center for Diarrheal Disease Research, Bangladesh (iccddr,b) hospital in Dhaka to estimate transmission parameters such as R0, and then scaled to the entire country by refitting to estimates of rotavirus disease burden for Bangladesh. We calculated medical costs associated with each health outcome and determined the cost of introducing the rotavirus vaccine. We used these estimates to develop an Excel model that examined the incremental cost effectiveness, from the health care system perspective, of introducing rotavirus vaccine into Bangladesh’s National Immunization Program. The outcome measure selected was discounted (3%) US$ per Disability Adjusted Life Year (DALY) averted, in children under five.

RESULTS: According to our model, vaccine introduction would prevent ~49,000 deaths over ten years. Under vaccination, 10.2 million discounted DALYs would be averted, and $25.7 million in discounted costs of treating rotavirus infection would be saved; the total discounted cost of vaccine introduction would be $550 million. The incremental cost per DALY saved was $51.19, and varied from $6.80 to $78.0 per DALY averted when conducting one-way sensitivity analyses of model variables. The variables that had the biggest impact on the cost per DALY were vaccine efficacy, vaccine price and annual number of rotavirus episodes.

CONCLUSION: Judged by the WHO’s widely-accepted standards, introduction of rotavirus vaccination to Bangladesh is very cost-effective and would likely be instrumental in decreasing morbidity and mortality caused by rotavirus in children under five.

Comments

This is an Open Access Thesis.

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