196853 Economic burden of childhood rotavirus infection and cost-effectiveness of universal vaccination in Bolivia

Wednesday, November 11, 2009: 12:30 PM

Emily R. Smith, MPH , Hubert Department of Global Health, Emory University, Atlanta, GA
Volga Iniguez, PhD , Universidad Mayor San Andres, La Paz, Bolivia
Rick Rheingans, PhD , Hubert Department of Global Health, Emory University, Atlanta, GA
Emily Rowlinson, MPH , Hubert Department of Global Health, Emory University, Atlanta, GA
Kizee Etienne, MPH , Hubert Department of Global Health, Emory University, Atlanta, GA
Rosario Rivera , Universidad Mayor San Andres, La Paz, Bolivia
Nataniel Mamani , Universidad Mayor San Andres, La Paz, Bolivia
Juan Leon, PhD, MPH , Hubert Department of Global Health, Emory University, Atlanta, GA
Background: Diarrhea is responsible for one billion illnesses each year and 2 million deaths. In Bolivia, the under-five mortality rate is 65 deaths per 1,000, and diarrhea is responsible for 37% of these deaths. In Bolivia, surveillance suggests that 40% of pediatric gastroenteritis-related hospitalizations are a result of rotavirus. New rotavirus vaccines may be an important intervention, although high costs pose a barrier to implementation. The goal of our study was to quantify the economic burden of rotavirus and assess the cost-effectiveness of universal vaccination. Methods: Treatment costs were collected by abstracting medical records to assess costs to the healthcare system and conducting interviews with caregivers to assess costs to society. Data was collected over 3 years at seven sentinel hospitals, in four cities. More than 6,000 medical records and 400 caregiver interviews were included in the analysis. We used a decision-analytic model to assess the potential cost-effectiveness of universal rotavirus vaccination in Bolivia. Results: Our model estimates that annually 1,335 Bolivian children will die of rotavirus diarrhea, 3,377 will be hospitalized, and 14,467 will seek outpatient care. Further, the healthcare system will incur $866,732 annually in direct medical costs, and caregivers will spend more than $156,085. Rotavirus vaccination will be cost-effective for Bolivia at less than $7 per dose. Conclusions: This model suggests that, from an economic perspective, vaccination should be implemented to reduce costs to Bolivia's healthcare system. These data also serve as a baseline comparison for future studies examining the impact of rotavirus vaccination in Bolivia.

Learning Objectives:
•Evaluate the economic and child survival benefits of universal rotavirus vaccination in Bolivia. •Demonstrate the utility of using economic evaluations to implement new technologies, such as vaccines or other interventions, in low-income countries.

Keywords: International Public Health, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: EDUCATION Emory University, Atlanta, GA Anticipated May 2009 Master of Public Health. Global Environmental Health Northwestern University, Evanston, IL June 2006 Bachelor of Arts. Majors: Anthropology, International Studies, and Global Health Minor RESEARCH AND PUBLICATIONS Leon JS, Souza M, Wang Q, Smith ER, Saif LJ, Moe CL (2008). Immunology of Norovirus infection. Immunity against mucosal pathogens (Vajdy M. ed.). Springer Science. Boston. Smith ER, Iniguez V, Rowlinson EE, Etienne K, Rivera R, Mamani N, Leon JS. Healthcare Costs for Treatment of Rotavirus Gastroenteritis from the State Perspective and Potential Cost Effectiveness of Universal Rotavirus Vaccination in Bolivia. (in preparation) PROFESSIONAL EXPERIENCE The Leon Research Group, Emory University August 2008-Present Laboratory Manager ● Hire, train, manage and mentor laboratory research assistants in pursuit of group research and publication goals. ● Draft and administer $250,000 budget which ensures group salaries, lab maintenance, inventory, long-term project sustainability. ● Coordinate and submit project proposals, amendments and correspondence to Institutional Review Board. ● Oversee and contribute data collection and entry, data analysis and publication of data with U.S. and international team members. The Moe Research Group, Emory University June 2007 - Present Infectious Disease and Environmental Microbiology Research Assistant ● Provide technical and administrative assistance, including organizational development, hiring study staff, training employees, recruiting study volunteers, communicating with collaborators and organizing logistics for United States Department of Agriculture (USDA) Clinical Trials to study disease progression, immune response, and other aspects of Norovirus infection. ● Research and evaluate current literature regarding gastrointestinal disease, analyze data and contribute to publications in collaboration with research group through writing, editing, and creation of tables, graphs and figures. ● Analyze human samples using lab techniques including RNA extraction and purification, PCR, gel electrophoresis, and ELISA. Pan-American Health Organization National Rotavirus Surveillance Program, La Paz, Bolivia May 2008 – Present Quantifying the Economic Burden of Rotavirus in Bolivia, Independent Research and Epidemiological Consultant ● Design and implement national study including selection of study sites, creation of survey instruments, hiring and training of field staff, management of data from more than 500 surveys, and management of Bolivian research assistants from US. ● Collaborate with surveillance program and Ministry of Health to analyze epidemiologic data and utilize preliminary study results for publication and public service announcements in preparation for release of the Rotavirus Vaccine in Bolivia. ● Conduct or create all meetings, trainings, correspondence and study materials in Spanish and in a culturally appropriate manner.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.