Rotavirus disease burden and impact and cost- effectiveness of a rotavirus vaccination program in Kenya
Journal of Infectious Diseases
Centers for Disease Control and Prevention, United States; Emory University, Atlanta, GA, United States; University of Michigan, Ann Arbor, United States; Kenya Medical Research Institute, Centers for Disease Control and Prevention, Kisumu, Kenya; Kenya Medical Research Institute, Centers for Disease Control and Prevention, Nairobi, Kenya
Background. The projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds are available. Methods. Hospital records, health utilization surveys, verbal autopsy data, and surveillance data on diarrheal disease were used to determine rotavirus-specific rates of hospitalization, clinic visits, and deaths due to diarrhea among children <5 years of age in Nyanza Province, Kenya. Rates were extrapolated nationally with use of provincespecific data on diarrheal illness. Direct medical costs were estimated using record review and World Health Organization estimates. Household costs were collected through parental interviews. The impact of vaccination on health burden and on the cost-effectiveness per disability-adjusted life-year and lives saved were calculated. Results. Annually in Kenya, rotavirus infection causes 19% of hospitalizations and 16% of clinic visits for diarrhea among children <5 years of age and causes 4471 deaths, 8781 hospitalizations, and 1,443,883 clinic visits. Nationally, rotavirus disease costs the health care system $10.8 million annually. Routine vaccination with a 2- dose rotavirus vaccination series would avert 2467 deaths (55%), 5724 hospitalizations (65%), and 852,589 clinic visits (59%) and would save 58 disability-adjusted life-years per 1000 children annually. At $3 per series, a program would cost $2.1 million in medical costs annually; the break-even price is $2.07 per series. Conclusions. A rotavirus vaccination program would reduce the substantial burden of rotavirus disease and the economic burden in Kenya. © 2009 by the Infectious Diseases Society of America. All rights reserved.
diphtheria pertussis tetanus vaccine; Rotavirus vaccine; age distribution; article; cause of death; child; child hospitalization; childhood mortality; cost benefit analysis; cost effectiveness analysis; cost of illness; diarrhea; disability; disease surveillance; frequency analysis; health care cost; health care utilization; health service; health survey; hospital charge; hospital cost; household; human; Human rotavirus; infant; interview; Kenya; major clinical study; medical record; medical record review; outpatient department; parent; preschool child; priority journal; vaccination; virus infection; Cost of Illness; Cost-Benefit Analysis; Health Care Costs; Hospitalization; Humans; Immunization Programs; Kenya; Rotavirus Infections; Rotavirus Vaccines; Vaccination; World Health Organization