Cost-effectiveness of childhood vaccination against rotavirus in Norway

Background
Rotavirus is a leading cause of acute gastroenteritis among infants and children under 5 years old. In Norway, there are two vaccines (Rotarix® and Rotateq®) licensed for preventing rotavirus gastroenteritis. The Norwegian Knowledge Centre for the Health Services was assigned by the National Institute of Public Health to estimate the cost-effectiveness of including vaccination against rotavirus in the childhood immunization programme.

Methods
We performed a cost-utility analysis that compared costs and effects of the two vaccine alternatives to a non-vaccination strategy. The analyses were based on a model that estimated costs per quality adjusted life-years for the vaccine candidates. The results were presented as incremental cost-effectiveness ratios, and were presented both from a healthcare- and a societal perspective. NOK 500 000 per quality adjusted life-years gained was used as threshold for defining cost-effective interventions.

Results

Incremental cost-effectiveness ratios from a healthcare perspective:

• Rotarix®:          NOK 687 500 per quality adjusted life-year gained        
• Rotateq®:         NOK 762 000 per quality adjusted life-year gained   

Incremental cost-effectiveness ratios from a societal perspective:

• Rotarix®:          NOK 27 500 per quality adjusted life-year gained
• Rotateq®:         NOK 104 000 per quality adjusted life-year gained

Conclusions
With NOK 500 000 per quality adjusted life-years gained as threshold for cost-effectiveness, it is unlikely that vaccination against rotavirus will be a cost-effective intervention when viewed from a healthcare perspective. However, adopting a societal perspective, which also included indirect costs related to production losses from parent’s sick absence, the conclusion was changed to vaccination being considered a cost-effective intervention.