Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Virginia Pitzer

Second Advisor

Ernest Asare


Background: Despite the global introduction of rotavirus vaccinations across countries, Rotavirus infections continue to be a

leading cause of severe, dehydrating gastroenteritis in children under the age of 5 (Crawford et al., 2017). Bangladesh

experiences an extremely high burden where rotavirus infections contribute to 6,000–14,000 deaths each year in children <5

years of age (Rahman et al., 2007). A cost-effective analysis can aid decision-makers in determining the pros and cons of

introducing a rotavirus vaccination program in limited-resource countries.

Objective: A cost-effectiveness analysis was developed to evaluate the potential benefits of introducing rotavirus vaccination.

The analysis performed aims to inform key decision-makers about the costs and benefits of introducing rotavirus vaccination

in Bangladesh and help guide their decision on whether to implement such a program.

Methods: To better quantify vaccine impact and identify the optimal dosing schedule to improve vaccine performance as well

as demonstrate the cost-effectiveness of rotavirus vaccines, previously developed, and validated mathematical models of

rotavirus transmission for Dhaka, Bangladesh were used to project the potential impact of rotavirus vaccines over 10 years.

Continuing to build off the previous modeling, identifying input parameters to include in the cost-effectiveness model was

conducted. Extension of the developed rotavirus model for Dhaka, Bangladesh to include vaccines, run projected vaccination

impact across different dosing schedules for ROTAVAC and ROTARIX vaccination programs, estimate moderate-to-severe

and non-severe rotavirus annual incidence and organize the input variables for cost-effective analysis.

Results: The optimal dosing strategy across all schedules is shown to be 6/10/14. A 6/10/14 schedule of ROTARIX or

ROTAVAC is the optimal strategy at a WTP threshold >=$200. However, the lower the WTP threshold is, no vaccination is the

preferred method. Our findings highlight the value of Gavi's support for rotavirus vaccine introduction in Bangladesh.

Conclusion: A cost-effectiveness analysis is a useful tool for evaluating the potential benefits and costs of rotavirus

vaccination because it enables decision-makers to compare the expected costs of a vaccination program with the expected

health benefits. They can provide decision-makers with the information to understand the potential impact of the vaccine in

terms of reducing the burden of rotavirus disease and associated costs, such as healthcare expenditures and lost productivity.

It can also help to identify which vaccination strategies are cost-effective and prioritize limited resources towards the most

efficient use of funds. Ultimately, a cost-effectiveness analysis can inform the policy decisions Bangladesh needs to jumpstart

the implementation of rotavirus vaccination and ensure that resources are used in an effective way to improve public health



This is an Open Access Thesis.

Open Access

This Article is Open Access