Josephine van Dongen

3 Updated cost-effectiveness and risk-benefit analysis 63 population 11 . Fur ther parameter updates included changing the vaccination coverage for both targeted and universal vaccination from 88% (vaccine coverage Belgium 11 ) to 86% based on a recent assessment of willingness to vaccinate among Dutch parents 28 , changing the vaccine costs for a targeted vaccination strategy to the current market price of €135.32 per child 29 and changing the application costs to €12.36 per dose 30 . Vaccine costs for a universal vaccination within the national immunization program were kept at €75 per child, which assumes that tender processes will lower vaccine prices by almost 50% 11, 31 . Intussusception Our previous model 11 was extended to include the risk of developing IS following rotavirus vaccination. Based on the available literature, we assumed a vaccine-induced IS rate of 1:50,000 32-35 , whereof 4.8% would result in complications ( 36 , Table 1 ). The associated QALY loss for uncomplicated IS was 0.0037 37 , and costs were based on the average length of stay (LOS; 2.11 days) for IS in the Netherlands ( Table 1 , see Additional file 1 for details). Threefold higher estimates, representing the 95% percentile of the LOS distribution, were used for complicated IS cases (see Additional file 1 for details). Parental work loss was based on LOS, and we assumed that an average caregiver works 16.4 h/week, based on the mean weekly workhours among the primary caregivers according to Statistics Netherlands in 2014 38 . Model The model has been described previously 11 ; see Fig. 2 . In brief, we used an age- and risk- group structured, discrete-time event, stochastic multi-cohor t model of the Dutch pediatric population. The model used separate estimates for the number, and the costs of, community- acquired and nosocomial rotavirus cases, stratified by risk stratus into healthy vs medical risk conditions, the latter qualifying for targeted vaccination ( Table 1 ).The effect of either targeted or universal infant vaccination was modeled as a reduction in rotavirus AGE and associated health outcomes in vaccinated and non-vaccinated age cohor ts between 0 and 15 years old, stratified by risk status. Time steps of 1 month were used for ages 0 to 11 months and time steps of 1 year for ages 1 to 15.A time horizon of 20 years was used with year 1 being the star t of either vaccination program.