Background: In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. Methods: To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. Results: Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. Discussion: Our data will guide Bolivia's funding allocation for RV as international subsidies change.
Nota bibliográficaFunding Information:
This work was supported in part by The Eugene J. Gangarosa Fund , the Anne E. and William A. Foege Global Health Fund , the O.C. Hubert Charitable Trust , the RSPH Student Initiative Fund , the NIH Global Frameworks Grant (2007–2010), the Emory University Global Health Institute , the New Aid Fellowship, the Bolivia National Rotavirus Surveillance Program (BNRSP), and the Swedish Cooperation ASDI-UMSA. J.S.L. was supported in part by funds from the Emory University Global Health Institute , NIH-NIAID ( 1K01AI087724-01 ) and USDA-NIFA ( 2010-85212-20608 ) grants. Thank you also to Ms. Danielle Wagner, Jennifer King, and Sally Embrey who helped in the review of this manuscript and collection of relevant references. Thank you to Mr. Scott Wright for his technical assistance with the analysis. We are grateful for the support of the hospital staff participating in this study.
While many Latin American countries have undertaken cost-effectiveness analyses to facilitate policy decisions regarding rotavirus vaccination, Bolivia remains an exception. Bolivia is one of the least developed countries in the Americas, with nearly 60% of the population living in conditions of poverty and nearly 25% living in conditions of extreme poverty  . The nation suffers from the region's highest rates of childhood mortality, and the World Health Organization (WHO) estimates that diarrhea is responsible for 15% of these deaths  . In 2008, Bolivia implemented a universal rotavirus vaccination campaign with financial support from The Global Alliance for Vaccines and Immunization (GAVI) through the year 2017. The goal of this paper is to fill gaps in knowledge regarding the economic burden of rotavirus and cost-effectiveness of the rotavirus vaccination program in Bolivia. The subsequent analysis provides data for decision makers regarding the projected economic impact of vaccination at a range of vaccine prices reflecting the dynamic market value of this vaccine.