-
Cost Effectiveness and Resource... 2018Cost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs... (Review)
Review
BACKGROUND
Cost-effectiveness analysis (CEA) is frequently used as an input for guiding priority setting in health. However, CEA seldom incorporates information about trade-offs between total health gains and equity impacts of interventions. This study investigates to what extent equity considerations have been taken into account in CEA in low- and middle-income countries (LMICs), using rotavirus vaccination as a case study.
METHODS
Specific equity-related indicators for vaccination were first mapped to the Guidance on Priority Setting in Health Care (GPS-Health) checklist criteria. Economic evaluations of rotavirus vaccine in LMICs identified via a systematic review of the literature were assessed to explore the extent to which equity was considered in the research objectives and analysis, and whether it was reflected in the evaluation results.
RESULTS
The mapping process resulted in 18 unique indicators. Under the 'disease and intervention' criteria, severity of illness was incorporated in 75% of the articles, age distribution of the disease in 70%, and presence of comorbidities in 5%. For the 'social groups' criteria, relative coverage reflecting wealth-based coverage inequality was taken into account in 30% of the articles, geographic location in 27%, household income level in 8%, and sex at birth in 5%. For the criteria of 'protection against the financial and social effects of ill health', age weighting was incorporated in 43% of the articles, societal perspective in 58%, caregiver's loss of productivity in 45%, and financial risk protection in 5%. Overall, some articles incorporated the indicators in their model inputs (20%) while the majority (80%) presented results (costs, health outcomes, or incremental cost-effectiveness ratios) differentiated according to the indicators. Critically, less than a fifth (17%) of articles incorporating indicators did so due to an explicit study objective related to capturing equity considerations. Most indicators were increasingly incorporated over time, with a notable exception of age-weighting of DALYs.
CONCLUSION
Integrating equity criteria in CEA can help policy-makers better understand the distributional impact of health interventions. This study illustrates how equity considerations are currently being incorporated within CEA of rotavirus vaccination and highlights the components of equity that have been used in studies in LMICs. Areas for further improvement are identified.
PubMed: 29796012
DOI: 10.1186/s12962-018-0102-2 -
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese... Jul 2020In 1999, since the Rotashield, the first generation of oral Rotavirus vaccine has been confirmed that there is a link to intussusception, mainly occurs in 7 days after...
In 1999, since the Rotashield, the first generation of oral Rotavirus vaccine has been confirmed that there is a link to intussusception, mainly occurs in 7 days after first dose. With the second generation of RV vaccine has been listed globally and intussusception monitoring has continued. This study reviewed the current phase Ⅲ clinical and post-marketing studies of rotavirus vaccines on the market and found that the two most widely used rotavirus vaccines, RV1 and RV5, were found the risk of intussusception increased within 7 days of ORV. The Lanzhou lamb rotavirus vaccine (LLR), which manufactured by Lanzhou Institute of Biological Products Co, also lacks Epidemiological surveies. With the introduction of RV5 in 2018, the role of rotavirus vaccine in the prevention and efforts of severe rotavirus diarrhea is increasing. It is urgent to establish an intussusception active monitoring system to monitor the incidence of intussusception after rotavirus vaccine and provide more evidence for the post-marketing evaluation of the rotavirus vaccine.
Topics: Humans; Infant; Intussusception; Rotavirus; Rotavirus Infections; Rotavirus Vaccines; Vaccines, Attenuated
PubMed: 32842305
DOI: 10.3760/cma.j.cn112150-20191115-00860 -
The Journal of Infectious Diseases May 2024Even moderate differences in rotavirus vaccine effectiveness against nonvaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Even moderate differences in rotavirus vaccine effectiveness against nonvaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine effect or natural temporal fluctuations underlie observed changes in genotype distributions is unclear.
METHODS
We systematically reviewed studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023. We compared rotavirus genotypes between vaccine-introducing and nonintroducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction.
RESULTS
Crude pooling of genotype data from 361 studies indicated higher G2P[4], a nonvaccine genotype, prevalence in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas, the only region with robust longitudinal data. Relative to nonintroducing settings, G2P[4] detections were more likely in settings with recent introduction (eg, 1-2 years postintroduction adjusted odds ratio [aOR], 4.39; 95% confidence interval [CI], 2.87-6.72) but were similarly likely in settings with more time elapsed since introduction, (eg, 7 or more years aOR, 1.62; 95% CI, .49-5.37).
CONCLUSIONS
When accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Increased prevalence of G2P[4] may be transient after rotavirus vaccine introduction.
Topics: Rotavirus Vaccines; Humans; Rotavirus; Rotavirus Infections; Genotype; Child, Preschool; Infant; Global Health; Vaccination
PubMed: 37738554
DOI: 10.1093/infdis/jiad403 -
Human Vaccines & Immunotherapeutics 2018An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and...
An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and lower-middle income countries. Since 2009 the World Health Organization (WHO) recommends the use of rotavirus vaccines in all national immunization programs. This review compares rotavirus vaccine (RV) introductions and vaccine coverage by region, country income status and Gavi-eligibility from 2006-2016. Gross National Income data from the World Bank and surviving infant population from United Nations Population Division was obtained for 2016. Data from WHO were collected on rotavirus vaccine coverage, national immunization schedules, and new vaccine introductions for 2016 while estimated rotavirus deaths were collected for 2013, the last year of available WHO data. As of December 2016, the majority of countries (57%, 110/194) had not introduced universal rotavirus vaccine despite WHO's 2009 recommendation to do so. Countries in the WHO African region had the greatest proportion of introductions (37%, 31/84) by December 2016 and a great majority of these (77%, 24/31) were supported by new vaccine introduction (NVI) grants from Gavi. Almost half (48%) of global introductions were in low and lower-middle income Gavi-eligible and Gavi-graduating countries. Conversely, countries in the Southeast Asia WHO region and those not eligible for Gavi NVI support have been slow to introduce rotavirus vaccine. High-income countries, on average, had poorer rotavirus vaccine coverage compared to low and lower-middle income countries. The over-representation of African countries within the Gavi subset and high estimated rotavirus deaths in these African countries, likely explains why introduction efforts have been focused in this region. While much progress has been made with the integration and implementation of rotavirus vaccine into national immunization programs, 110 countries representing 69% of the global birth cohort had yet to introduce the vaccine by December 2016.
Topics: Capital Financing; Disease Transmission, Infectious; Global Health; Humans; Immunization Programs; Infant; Rotavirus Infections; Rotavirus Vaccines; Vaccination Coverage
PubMed: 29787334
DOI: 10.1080/21645515.2018.1470725 -
Human Vaccines & Immunotherapeutics 2014To assess the comparative effectiveness of a monovalent and a pentavalent rotavirus vaccine (RV1 and RV5), a Bayesian network meta-analysis was conducted. Data of... (Comparative Study)
Comparative Study Meta-Analysis Review
Bayesian network meta-analysis suggests a similar effectiveness between a monovalent and a pentavalent rotavirus vaccine: a preliminary report of re-analyses of data from a Cochrane Database Systematic Review.
To assess the comparative effectiveness of a monovalent and a pentavalent rotavirus vaccine (RV1 and RV5), a Bayesian network meta-analysis was conducted. Data of randomized trials from the Cochrane Review in 2012 were extracted and synthesized. For the prevention of severe rotavirus disease up to 2 years, no statistical difference was found in the effectiveness between the 2 types of vaccine (odds ratio: 2.23, 95% credible interval: 0.71-5.20). Similarly, the comparative effectiveness of RV1 and RV5 appeared equivalent for other rotavirus-associated outcome measures, such as prevention of severe disease up to 1 year and all severity of rotavirus infections for up to both 1- and 2-year follow-ups. These results indicates that, overall, RV1 and RV5 offer similar benefits to prevent rotavirus diseases; nonetheless, credible intervals are generally wide, highlighting the necessity of further meta-analyses including updated information or, ideally, controlled trials comparing both vaccines directly.
Topics: Bayes Theorem; Databases, Factual; Humans; Research Report; Rotavirus Infections; Rotavirus Vaccines; Treatment Outcome; Vaccines, Attenuated
PubMed: 24608099
DOI: 10.4161/hv.28284 -
Frontiers in Pharmacology 2019The vaccine against the rotavirus is an effective measure in reducing hospitalizations and mortality caused by the virus. However, its use can result in serious adverse...
The vaccine against the rotavirus is an effective measure in reducing hospitalizations and mortality caused by the virus. However, its use can result in serious adverse effects. The available evidence on Kawasaki disease has not yet been reported in the literature. This study investigated the risk of developing Kawasaki disease with the use of rotavirus vaccines in children. This is a systematic review of data collected from studies retrieved on the following databases: Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, HealthSTAR, Lilacs, Clinical trial.gov, and International Clinical Trials Registry Platform, up to the 15 of August 2018, with no restrictions on language or date of publication. The outcomes measured were incidence of Kawasaki disease, risk of developing the disease, and rate of discontinuation of the vaccination schedule. Four reviewers independently selected the studies, performed data extraction, and assessed the quality of evidence. A meta-analysis of random effects was performed. A total of 13 publications were included, with a population of 164,434 children included in the meta-analysis. The incidence of Kawasaki disease (24 cases per 100,000, 95% CI = 11.98-48.26) in the vaccinated children was low. No difference between the vaccines was found in the prevalence rate of adverse effects (RR = 1.55, 95% CI = 0.41-5.93). Use of the vaccines was not associated with risk of developing Kawasaki disease (low-quality evidence). None of the studies reported the rate of discontinuation of the vaccination schedule. The vaccines were associated with a low incidence of developing Kawasaki disease, showing no association with this serious adverse effect.
PubMed: 31616298
DOI: 10.3389/fphar.2019.01075 -
Vaccine Apr 2012Of the estimated half-million deaths from rotavirus globally each year, approximately one-third (N = 160,000 deaths) occur in the Indian subcontinent (defined as India,... (Review)
Review
Of the estimated half-million deaths from rotavirus globally each year, approximately one-third (N = 160,000 deaths) occur in the Indian subcontinent (defined as India, Bangladesh, and Pakistan). Two commercial vaccines are available for use and recommended by WHO, although the prohibitive vaccine price has limited their introduction into routine childhood immunization programs. New rotavirus vaccines are in late clinical development, including two advanced candidates in India. As significant shifts in rotavirus strain diversity have occurred in the past three decades and questions remain regarding whether strain replacement may occur following introduction of rotavirus vaccines, it is important to understand the temporal and regional strain diversity profile before vaccine introduction. We reviewed 33 peer-reviewed manuscripts from the Indian subcontinent and found that the most common G-types (G1-4) and P-types (P[4] and P[8]) globally accounted for three-fourths of all strains in the subcontinent. However, strains varied by region, and temporal analysis showed the decline of G3 and G4 in recent years and the emergence of G9 and G12. Our findings underscore the large diversity of rotavirus strains in the Indian subcontinent and highlight the need to conduct surveillance on a regional scale to better understand strain diversity before and after rotavirus vaccine introduction.
Topics: Bangladesh; Genetic Variation; Genotype; Humans; India; Molecular Epidemiology; Pakistan; Rotavirus; Rotavirus Infections
PubMed: 22520122
DOI: 10.1016/j.vaccine.2011.10.002 -
Vaccine Feb 2012Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of... (Review)
Review
BACKGROUND
Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of rotavirus strains in Asia.
METHODS
We searched MEDLINE, EMBASE and the World Health Organization (WHO) website for the term "rotavirus" and the name of each country. We included studies that were conducted in children between 2000 and 2011 and that examined the epidemiology, health and/or economic burden of RVGE, and G and P-type distribution in Eastern, South East, Southern and Central Asia. Random effects models were used to pool the proportions of RVGE. We also estimated child mortality due to RVGE using the updated WHO and United Nations Children's Fund's mortality estimates in 2008.
RESULTS
The search identified 113 eligible articles. The incidence rates of rotavirus-related hospitalizations in children under 5 years of age ranged from 2.1 to 20.0 cases per 1000 children per year with the highest rates reported in Bangladesh, South Korea, Taiwan, Thailand, and Vietnam. Rotavirus accounted for 37.5% of year-round hospitalized gastroenteritis cases, with higher proportions reported in South East Asia. Rotavirus was associated with approximately 145,000 deaths every year in Asia, with the greatest numbers occurring in India, Pakistan, and Indonesia. The highest annual societal costs of treating RVGE were reported in China (US$365 million), followed by Japan (US$254 million) and India (US$41-72 million). A diversity of rotavirus G and P-types was observed across Asia and the distribution of strains differed by country and year. The most common strains were G1P[8] (23.6%), G2P[4] (11.8%), G3P[8] (18.9%), and G9P[8] (7.4%).
CONCLUSIONS
Rotavirus is associated with substantial hospitalizations and deaths among children and causes large healthcare expenditures throughout Asia. Safe and effective rotavirus vaccines could substantially reduce the burden of disease.
Topics: Adolescent; Asia; Child; Child Mortality; Child, Preschool; Female; Gastroenteritis; Health Expenditures; Hospitalization; Humans; Immunization; Incidence; Infant; Male; Retrospective Studies; Rotavirus; Rotavirus Infections; Rotavirus Vaccines
PubMed: 22212128
DOI: 10.1016/j.vaccine.2011.12.092 -
Vaccine Jul 2013To review the approaches used in the cost-effectiveness analysis (CEAs) literature to estimate the cost of expanded program on immunization (EPI) activities, other than... (Review)
Review
OBJECTIVE
To review the approaches used in the cost-effectiveness analysis (CEAs) literature to estimate the cost of expanded program on immunization (EPI) activities, other than vaccine purchase, for rotavirus and pneumococcal vaccines.
METHODS
A systematic review in PubMed and NHS EED databases of rotavirus and pneumococcal vaccines CEAs was done. Selected articles were read and information on how EPI costs were calculated was extracted. EPI costing approaches were classified according to the method or assumption used for estimation.
RESULTS
Seventy-nine studies that evaluated cost effectiveness of rotavirus (n=43) or pneumococcal (n=36) vaccines were identified. In general, there are few details on how EPI costs other than vaccine procurement were estimated. While 30 studies used some measurement of that cost, only one study on pneumococcal vaccine used a primary cost evaluation (bottom-up costing analysis) and one study used a costing tool. Twenty-seven studies (17 on rotavirus and 10 on pneumococcal vaccine) assumed the non-vaccine costs. Five studies made no reference to additional costs. Fourteen studies (9 rotavirus and 5 pneumococcal) did not consider any additional EPI cost beyond vaccine procurement. For rotavirus studies, the median for non-vaccine cost per dose was US$0.74 in developing countries and US$6.39 in developed countries. For pneumococcal vaccines, the median for non-vaccine cost per dose was US$1.27 in developing countries and US$8.71 in developed countries.
CONCLUSIONS
Many pneumococcal (52.8%) and rotavirus (60.4%) cost-effectiveness analyses did not consider additional EPI costs or used poorly supported assumptions. Ignoring EPI costs in addition to those for vaccine procurement in CEA analysis of new vaccines may lead to significant errors in the estimations of ICERs since several factors like personnel, cold chain, or social mobilization can be substantially affected by the introduction of new vaccines.
Topics: Cost-Benefit Analysis; Developed Countries; Developing Countries; Health Care Costs; Humans; Immunization Programs; Pneumococcal Vaccines; Rotavirus Vaccines
PubMed: 23777697
DOI: 10.1016/j.vaccine.2013.05.064 -
The American Journal of Tropical... Apr 2018Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects... (Meta-Analysis)
Meta-Analysis
Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects remains unknown. We systematically reviewed the literature and quantified indirect rotavirus vaccine effectiveness (VE) for preventing rotavirus hospitalization in children aged less than 5 years. From 148 identified abstracts, 14 studies met our eligibility criteria. In our main analysis using a random-effects model, indirect rotavirus VE was 48% (95% confidence interval [CI]: 39-55%). In a subgroup analysis by country income level, indirect VE was greater in high-income countries (52%; 95% CI: 43-60%) than in low- and middle-income countries (LMICs) (25%; 95% CI: 5-41%). In a sensitivity analysis using a quality-effects model, the indirect VE in LMICs was not statistically significant (25%; 95% CI: 0-44%). Our findings highlight the importance of increasing rotavirus vaccine coverage, particularly in LMICs where evidence for indirect VE is limited and rotavirus burden is high.
Topics: Child, Preschool; Hospitalization; Humans; Income; Infant; Infant, Newborn; Rotavirus Infections; Rotavirus Vaccines
PubMed: 29436336
DOI: 10.4269/ajtmh.17-0705