Rotavirus vaccination in children likely cost-saving in Hong Kong

An evaluation of the cost-effectiveness of two rotavirus vaccines, carried out by researchers in Hong Kong, the UK and the US, shows that vaccination is likely to be cost-saving to the Hong Kong government and payers.

“Rotavirus gastroenteritis [RVGE] causes significant morbidity in young children and a high economic burden in Hong Kong. An estimated 1 in 33 Hong Kong children are hospitalized for RVGE by the age of 5 years,” stated the researchers. [J Infect Dis 2005;1:S71-S79; Vaccine 2014;32:1700-1706; J Infect Dis 2005;1:S64-S70]

“The WHO recommends that all national immunization programmes include rotavirus vaccines, but it has not yet been included in the Hong Kong government’s Childhood Immunization Programme [CIP],” wrote the researchers. [Rotavirus vaccines: WHO position paper – January 2013. World Health Organization; 2013. Report #5] “Our study aimed to evaluate the cost-effectiveness of two rotavirus vaccines licensed in Hong Kong, namely the monovalent two-dose Rotarix and the pentavalent three-dose RotaTeq, for both the governmental and overall health sectors [governmental plus patient], by comparing each vaccine to a scenario without rotavirus vaccination.” [Vaccine 2021;39:45-58]

Rotarix has shown 96–97 percent efficacy in high-income Asian cities/countries, including Hong Kong. Both Rotarix and RotaTeq were reported to be safe and highly efficacious in two seminal clinical studies in Europe and the US. [Vaccine 2012;30:4552-4557; N Engl J Med 2006;354:11-22; N Engl J Med 2006;354:23-33] A test-negative case-control study has confirmed 89–95 percent effectiveness against rotavirus hospitalizations in Hong Kong children younger than 5 years of age. [Vaccine 2016;34:4935-4942]

“Over the period of 2020 to 2029, the discounted costs of rotavirus vaccination would be USD 51 million and USD 57 million based on the per-course price of USD 72 [Rotarix] or USD 78 [RotaTeq], but this would be offset by discounted treatment cost savings of USD 70 million to the Hong Kong government and USD 127 million to both the government and patients, making the introduction of rotavirus vaccine into the Hong Kong CIP a cost-saving intervention,” reported the researchers.

Currently, guardians who would like their children vaccinated with rotavirus vaccine can only do so in the private sector and pay out-of-pocket. “The private sector price is very high compared with the anticipated tender price of the vaccine, should it be included in the CIP. With rotavirus vaccination in the CIP, USD 13–20 million and USD 70–77 million could be saved for the government alone and the government plus patient health sector, respectively, over a 10-year period,” noted the researchers.

To evaluate the expected benefit-risk ratio of vaccination, the researchers also evaluated the potential increase in the number of intussusception hospitalizations (a rare bowel disorder) that could be caused by the vaccine, and the number of seizures that could be prevented. They estimated that approximately 700 RVGE and 300 seizure hospitalizations could be prevented for each extra intussusception hospitalization caused.

“Over the period of 2020–2029, rotavirus vaccination could prevent 49,000 [95 percent uncertainty interval (UI): 44,000–54,000] RVGE and seizure hospitalizations and cause approximately 50 [95 percent UI: 25–85] intussusception hospitalizations, resulting in a benefit-risk ratio of approximately 1000:1 [95 percent UI: 550–2000:1], which is higher than the estimates for low-mortality countries such as Australia, England, France, Japan, and Singapore,” reported the researchers.