Updating and refining of economic evaluation of rotavirus vaccination in Spain: A cost-utility analysis

Background: Two vaccines against rotavirus diseases, Rotarix® and RotaTeq®, are being marketed in Spain; but rotavirus is not among diseases covered by universal vaccination in Spain. The aim was to assess the efficiency of extending Spain’s current targeted rotavirus vaccination strategy including only preterm babies, to a policy of universal vaccination. Methods A de novo cohort-based Markov model was built to evaluate the efficiency of three rotavirus vaccination strategies in Spain, i.e., targeted, universal, and no vaccination. Using Rotarix® or RotaTeq®, we compared the cost-utility of these strategies from both a societal and Spanish National Health System (SNHS) perspective. The model represents the most important clinical events conceivably linked to rotavirus infection. Efficacy, effectiveness, safety, costs and utilities were identified by systematic reviews. Results Incremental cost-utility threshold (ICUR) is €23,638/QALY (Quality Adjusted Life Year) for targeted vaccination with Rotarix®. The ICUR for the rest of the strategies evaluated are above €30,000/QALY. Sensitivity analysis shows the price as the only parameter that could make the universal vaccination strategy efficient. Conclusions Considering a threshold of €25,000/QALY, only targeted vaccination with Rotarix® from the societal perspective would be efficient. Price drops of 36.9% for Rotarix® and 44.6% for RotaTeq® would make universal vaccination efficient.