An update of cost-effectiveness of rotavirus vaccination in indonesia: Takinga birth-dose vaccination strategy into account

Objectives: Rotavirus infection was reported as the major cause of severe diarrhea in children under 5-years-old in Indonesia. A low cost rotavirus vaccine to protect infants from birth has been developed for developing countries, such as Indonesia. This study aims to update our initial analysis on the cost-effectiveness of rotavirus vaccination in Indonesia, taking a birth-dose vaccination strategy explicitly into account. Methods: An age-structured cohort model was developed for the 2013 Indonesia birth cohort. Applying different rotavirus vaccine efficacies for formula-fed and breastfed infants, we compared two vaccination strategies: (i) three-dose schedule at 2, 3 and 4 months of age, and (ii) three-dose schedule at 0, 1, and 2 months of age. We applied a 5-year-time-horizon with 1 monthly analytical cycles for children less than 1 year of age and annually thereafter. Also, we used Monte Carlo simulations to examine the economic acceptability and affordability of the rotavirus vaccination. Results: Rotavirus vaccination would reduce rotavirus-diarrhea cases in children under 5-years-old by 475,806 and 489,259 cases for the first and second strategies, respectively. Considering amarket price of US$ 5 per dose, the Indonesian government would require budgets of US$ 65.0 million and US$ 65.3 million for the first and second strategies, respectively.The incremental cost-effectiveness ratios wereUS$ 150 and US$ 146for the first and second strategies, respectively, which were much lower than the 2013 Indonesian Gross Domestic Product (GDP) per capita of US$ 4,790. Conclusions: The implementation of a birth-dose rotavirusvaccination strategy in Indonesia would be more cost-effective than a later vaccination schedule. The mortality rate and vaccine price were the most influential parameters impacting the costeffectiveness results