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

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.