Josephine van Dongen

Chapter 3 70 Under base-case assumptions and using a societal perspective, universal vaccination would become cost-saving at vaccine costs of €32 per child when compared to a strategy with no vaccination, or at €24.5 per child when compared to a strategy with targeted vaccination.The alternative universal vaccination scenario, where the vaccine would not be covered by the publicly funded national immunization program but purchased individually at market prices, was not considered cost-effective at an ICER of €119,191/QALY (95% credibility interval (CI) €70,488/QALY–€244,692/QALY) (see Fig. 3 and Additional file 2: Table S3 ). Vaccination aver ts fatal rotavirus cases and hospitalization (benefits), but at the costs (risk) of inducing IS cases.The risk-benefit ratio differed by health status of the vaccinated child ( Table 3 ). Among infants with medical risk conditions, we estimated a benefit of 21 prevented fatal rotavirus cases and 1707 prevented rotavirus hospitalizations for every vaccine-induced IS case. In healthy children the estimated risk-benefit ratio resulted in 0.05 prevented fatal cases and 571 hospitalized cases for every vaccine-induced IS case. Table 3 Risk-benefit ratios for rotavirus vaccination Induced IS: pre- vented fatal cases Induced IS: pre- vented hospital- ized cases Induced compli- cated IS: prevent- ed fatal cases Induced compli- cated IS: prevent- ed hospitalized cases All children Targeted vacci- nation 1:21 (1:12–1:33) 1:1707 (1:1494– 1:1920) 1:445 (1:244– 1:691) 1:35,564 (1:31,126– 1:39,995) Universal vacci- nation 1:1.8 (1:1.0–1:2.8) 1:685 (1:603– 1:767) 1:37 (1:20–1:59) 1:14,267 (1:12,566– 1:15,974) Targeted group Targeted vacci- nation 1:21 (1:12–1:33) 1:1707 (1:1494– 1:1920) 1:445 (1:244– 1:691) 1:35,564 (1:31,126– 1:39,995) Universal vacci- nation 1:22 (1:12–1:34) 1:2012 (1:1773– 1:2252) 1:455 (1:250– 1:706) 1:41,913 (1:36,942– 1:46,921) Healthy children Targeted vacci- nation NA NA NA NA Universal vacci- nation 1:0.05 (1:0.00– 1:0.16) 1:571 (1:503– 1:639) 1:1.0 (1:0.03– 1:3.24) 1:11,896 (1:10,475– 1:13,319)