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Economic Impact of Immunization Against Rotavirus GastroenteritisEvidence From a Clinical Trial
Robert I. Griffiths, MS, ScD;
Gerard F. Anderson, PhD;
Neil R. Powe, MD, MPH, MBA;
Elizabeth Oliveras;
Robert J. Herbert, MS;
Cameron C. Grant, MBChB, FRACP;
Bruce L. Davidson, MD, MPH
Arch Pediatr Adolesc Med. 1995;149(4):407-414.
Abstract
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Objective
To estimate the economic impact of immunization against rotavirus gastroenteritis in an infant population in the United States.
Design
Cost identification and break-even analyses from the perspective of society, nested within a phase 3, randomized, double-blind, placebo-controlled trial.
Patients
Infants (N=1278), aged 6 to 22 weeks, enrolled during the summer and fall of 1991 and followed up until July 1, 1992.
Intervention
Immunization schedule of three doses of orally administered tetravalent or serotype 1 rhesus rotavirus vaccine, or placebo.
Main Outcome Measures
Incidence of rotavirus gastroenteritis, total direct medical costs, direct nonmedical costs, and indirect costs of rotavirus and nonrotavirus gastroenteritis for the duration of the study and of any illness during 5 days after each dose. The cost of the vaccine was not included.
Results
Median total cost per infant among the 1187 infants who completed the immunization schedule was $9 in the tetravalent vaccine group, $9 in the serotype 1 vaccine group, and $49 in the placebo group (P=.01). Rotavirus gastroenteritis occurred in 195 infants (16%): 13% (51/398) in the tetravalent group, 12% (47/404) in the serotype 1 group, and 25% (97/385) in the placebo group (P<.0001). Of infants with an episode of rotavirus gastroenteritis, the proportion who incurred cost during the episode and the median cost during the episode did not differ by treatment group. The baseline net cost savings for treatment of rotavirus gastroenteritis and break-even cost of immunization were $11 per infant for the tetravalent vaccine and $12 for the serotype 1 vaccine. In sensitivity analysis, savings ranged from $40 to –$6, because of a large variance in the costs of rotavirus gastroenteritis.
Conclusion
The results of the baseline analysis suggest that society should be willing to pay between $11 and $12 for immunization against rotavirus. It might be willing to pay an additional amount for the intangible benefits of reduced parental inconvenience or anxiety associated with this illness in infants.
(Arch Pediatr Adolesc Med. 1995;149:407-414)
Author Affiliations
From the Department of Health Policy and Management (Drs Griffiths, Anderson, and Powe, Mr Herbert, and Ms Oliveras) and Center for Hospital Finance and Management (Drs Griffiths and Anderson, Ms Oliveras, and Mr Herbert), The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md; The Johns Hopkins University School of Medicine; (Drs Griffiths, Powe, and Grant); and Clinical Epidemiology Section, Division of Allergy, Critical Care, and Pulmonary Medicine, Hahnemann University, Philadelphia, Pa (Dr Davidson). Dr Griffiths is now with Health Technology Associates Inc, Washington, DC. Dr Grant is now with the Department of Paediatrics, University of Auckland (New Zealand) School of Medicine.
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