Cost and cost-effectiveness of childhood vaccination against rotavirus in France

Summary Objectives To assess the effectiveness and cost-effectiveness of routine childhood vaccination by new vaccines against rotavirus in France. Methods We constructed a Markov decision tree to compare two alternatives: “no vaccination” and “vaccination”. A hypothetical birth cohort of 750,000 children was followed until 3 years of age. First, the disease burden without vaccine was estimated using data from French databases and medical literature. Incidence rates in unvaccinated children were modelled as a function of age and seasons. Next, using data from the medical literature, the vaccine's protective effect on rotavirus diarrhoea was considered. Results A routine universal rotavirus immunization programme was estimated capable of annually avoiding 89,000 cases of diarrhoea, 10,500 hospitalizations, and 8 deaths. At a vaccination cost of €150/course, assuming 75% vaccine coverage, the programme would cost €95 million and involve a net loss of €68 million to the health care system. The vaccination programme would cost €298,000/year of life saved, and €138,000/QALY saved. Key variables affecting the results were disease incidence, mortality rates and vaccine price. Conclusion In France, childhood rotavirus vaccination with new antirotavirus vaccines would reduce the morbidity burden of rotavirus infection, but would not be cost-effective unless the price of vaccine decreased considerably.