Updating the cost-effectiveness of rotavirus vaccination in The Netherlands

OBJECTIVES: To investigated the most important factors responsible for the large differences in previously estimated cost-effectiveness ratios and to update the costeffectiveness of rotavirus vaccination in the The Netherlands applying assumptions resulting from 2 consensus meetings with national and international experts in the field, from academia, clinical environments, industry and health policy. METHODS: We constructed a decision analytic model to compare the expected net costs and health benefits over a period of 5 years in two hypothetical cohorts of 180,000 children (approximating the Dutch birth cohort), one being vaccinated and one unvaccinated. The base-case analysis refl ected the most likely-but also overall conservative-estimate of cost-effectiveness from the societal perspective. Robustness of the base-case result was investigated in sensitivity and scenario analyses. RESULTS: In the base-case analysis, it was estimated that approximately 59,495 RVGE cases would occur, resulting in 11,453 GP visits and 3,238 hospitalizations. With vaccination, approximately 34,000 cases of RVGE cases are averted corresponding to a total QALY gain of 167. Assuming a total cost of vaccination of €75, vaccination would result in cost-effectiveness of €30,540 per QALY gained (€152 per case averted). Results were sensitive to the number of deaths due to RVGE, inclusion of potential herd protection, inclusion of QALY decrements of care givers, further potential tender price reduction and the exact discount rate used. CONCLUSIONS: Our economic analysis indicates that a potential national immunization programme against rotavirus can be considered costeffective if applying a threshold of €50,000 per QALY for the The Netherlands