[PIN28] Impact of methodological choices and assumptions in economic evaluations of rotavirus vaccination

[PIN28] Impact of methodological choices and assumptions in economic evaluations of rotavirus vaccination

2010 Value in health

Millier, A. | Aballea, S. | Petrou, S. | Quilici, S. | Volume: 13, Issue: 7, Pages: A435, Vaccination, economic evaluation, vaccines, model, methods, epidemiology, Cost Savings, Value, Quality of Life, Caregivers,

OBJECTIVES: Rotavirus is the leading cause of severe gastroenteritis in children under
5 years. Two vaccines are currently available: RotaTeq® (Merck/Sanofi Pasteur MSD)
and Rotarix® (GSK). Published economic models on rotavirus vaccination have produced
contradicting results. We reviewed and critically appraised existing economic
models. METHODS: The literature search covered worldwide cost-effectiveness
models of RotaTeq® and Rotarix® published or presented at conferences until
October 2009. We extracted information on model structures, input data (epidemiology,
vaccine effi cacy, utilities, vaccination costs) and results. RESULTS: We identifi ed
44 publications referring to distinct cost-effectiveness analyses.18 used cost per QALY
as primary outcome, providing 22 incremental cost-utility ratios (ICURs) for highincome
countries. Thirteen ICURs came from health authorities and 9 from manufacturers.
While some European studies predicted cost-savings from societal perspective,
the ICUR was estimated at up c160,000 per QALY for the UK, from NHS perspective.
5 of 13 analyses from health authorities reported ICURs below c30,000 per QALY
gained, compared to 7 of 9 studies from manufacturers. There were many differences
between models, such as perspective, epidemiological inputs, vaccine effi cacy and
vaccination costs. However differences in results were mainly driven by assumptions
related to estimation of QALYs: utility values, duration of symptoms, inclusion of
quality of life burden for caregivers and for cases without medical attention. CONCLUSIONS:
Results of cost-effectiveness analyses are highly variable due to uncertainty
surrounding epidemiological inputs, and most importantly to assumptions for
deriving QALYs. Different choices were attributable to different value judgments, and
to the diffi culty of measuring and valuing quality of life in children, which lead to a
There is currently no valid reference case for cost-utility analyses in paediatrics. More
open communication and expertise sharing between authorities and manufacturers
could lead to more reliable analyses.