Table 1 Comparison of the two analyses using an Excel-based model: Rotavirus versus HPV [6, 15, 18, 19, 38–55]
Main features/Assumptions | Rotavirus | HPV |
|---|---|---|
Study design overview | Â | Â |
Country/Region | 72 GAVI-eligible countries | Same |
Study type | Cost-effectiveness analysis | Same |
Perspective | (Limited) societal perspective | Same |
Currency | 2005 international dollars (I$) | Same |
Base year for discounting | 2009 | Same |
Year of intervention | 2010 | Same |
Primary outcome measure | ICER (I$/DALY averted) | Same |
Discount rate (base-case) | Health outcome: 3%, Cost: 3% | Same |
Model type and structure | Â | Â |
Model type | Static cohort model (implicitly based on a decision tree) | Same |
Model outcomes | Costs Cases of rotavirus-associated deaths, hospitalizations, and outpatient visits Life years saved DALYs averted | Costs Cases of cervical cancer and cervical cancer deaths Life years saved DALYs averted |
Time horizon (span) | 5 years (ages 0-4) | Lifetime (ages 9-99) |
Software for programming | Microsoft Excel and VBA | Same |
Assumptions on intervention and vaccine efficacy | Â | |
Vaccine type | Rotarix® or Rotateq® (non-distinguished) | Gardasil® or Cervarix® (non-distinguished) |
Strategies | Routine versus no vaccination | Same |
Target population | Infants | 9-year-old girls |
Vaccination schedule | 2,4,and 6 months of age | The second and third doses administered 1 and 6 months after the first dose |
Coverage (base-case) | 70% | Same |
Vaccine efficacy (serotype-specific) | G1P[8]: 87% G3P[8]: 90% G4P[8]: 93% G9P[8]: 84% G2P[4], other combination:71% | 100% against cervical cancer caused by HPV 16/18 |
Vaccine efficacy adjusted for serotype distribution | Yes | Yes |
Assumptions on natural history | Â | Â |
Serotype distribution | Country-specific | Same |
Duration of vaccine immunity | 5 years (ages 0-4) | Lifetime (ages 9-99) |
Waning of vaccine-acquired immunity | No | No |
Natural immunity considered | No | No |
Herd immunity considered | No | No |
Assumptions on resource use | Â | Â |
Range of costs included | Direct medical costs (composite program costs and medical treatment costs) | Same |
Working definition and description of composite program costs | A composite vaccination program cost was defined to be a total cost per vaccinated individual for delivering a full course of vaccines, and was assumed to include the following cost items: vaccine purchase, vaccine wastage, freight and insurance, administrative cost, immunization support (including cold chain, training, and operational costs), and other programmatic costs (including surveillance and monitoring and social mobilization). For a composite cost of I$10 and I$25, vaccine purchase cost was US$4.5 (3 doses at US$.50 each) and US$15 (3 doses at US$5 each), respectively. | Same |
Levels of composite costs used in a comparative simulation | I$10 and I$25 | Same |
Medical utilization for treatment | 1) Rotavirus gastroenteritis requiring outpatient visit: one time outpatient clinic visit 2) Rotavirus gastroenteritis requiring hospitalization: one time outpatient visit plus a 3-day admission 3) Rotavirus gastroenteritis leading to deaths: one time outpatient visit plus a 3-day admission | Stage-specific treatment costs assume diagnostic workup, inpatient and outpatient visits, follow-up [6, 15] |
Access to care | 100% for the base-case (varied in a sensitivity analysis) | Same |
Sources of key data | Â | Â |
Population prospect | UN Population Prospect, The 2006 Revision [38] | Same |
Life expectancy | WHO life tables (year 2006) [39] | Same |
Incidence (rotavirus-associated deaths or cervical cancer) | WHO estimates [40] | 1) GLOBOCAN 2002 [41] 2) Cancer incidence in five continents (CI5C), vol. I-VIII [42] 3) Cancer in Africa [43] |
Treatment cost data | WHO-CHOICE [44] | WHO-CHOICE [44] |
Serotype distribution | Published literature [28] | |
Disability weights | Global Burden of Diseases 1990 [55] | Same |