Josephine van Dongen

3 Updated cost-effectiveness and risk-benefit analysis 69 We first compared targeted vaccination to no vaccination over a 20-year time horizon.With annual vaccination costs of €0.64 million, targeted vaccination would aver t on average 43,000 rotavirus AGE episodes and 99 fatal cases, and would induce 4.6 IS cases, of which 0.22 would be complicated cases. The targeted vaccination strategy would result in 1139 QALYs gained and €17 million savings ( Table 2 ). Targeted vaccination was cost-saving in all simulations ( Fig. 3 ) and remained cost-saving in all conducted sensitivity analyses ( Fig. 4a and Additional file 2: Table S2 ). We then compared the no vaccination strategy to universal vaccination, which would cost €15 million annually. Over a 20-year time horizon universal vaccination would aver t 665,000 rotavirus AGE episodes and 103 fatal cases and would induce 58.4 IS cases, of which 2.8 would be complicated. Universal vaccination would result in 1907 QALYs gained and €98 million additional costs ( Table 2 ) at an ICER of €51,280/QALY gained ( Fig. 2 and Additional file 2: Table S3 ).When universal vaccination was compared to targeted vaccination, the ICER increased to €149,280/QALY gained. Sensitivity analyses revealed that vaccine costs, presence and level of herd protection, the perspective chosen (i.e., healthcare costs only vs societal costs), the number of annual rotavirus hospitalizations, the costs per hospitalization, older age at first infection, and productivity losses were most influential on cost-effectiveness results ( Figs. 4, 5 and Additional file 2: Table S3 and Figure S1 ). Fig. 5 Mean ICER (cost per QALY gained) for universal vaccination vs no vaccination (green line/dots), and for universal vaccination vs targeted vaccination (black line/dots) using a societal perspective and assuming a discount rate of 3%, for different vaccine costs. Results are also presented in Table S3 in Additional file 2 (universal vaccination vs no vaccination) and in Table S4 in Additional file 2 (universal vaccination vs targeted vaccination).