Cost-effectiveness analysis for rotavirus vaccine decision-making: How can we best inform evolving and complex choices in vaccine product selection?

Abstract

Rotavirus vaccination has been a global health success story. In 2008, RotaTeq received World Health Organization (WHO) prequalification, which was followed by the prequalification of ROTARIX in 2009 [1]. Over the following decade, these two vaccines were introduced in around 100 countries’ immunization programs and have contributed to significant declines of the global rotavirus disease burden [2–5]. Then, in 2018, two new rotavirus vaccines made in India, ROTAVAC and ROTASIIL, also received WHO prequalification. This was a landmark achievement for the rotavirus community, as it expands product choice and has the potential to help lower prices, mitigate supply concerns, and enhance rotavirus vaccine impact around the world through the broader use of rotavirus vaccines, particularly in low- and middle- income countries. However, having a range of rotavirus vaccine options with heterogeneous characteristics including different presentations, dosing schedules, and prices can also present decisionmakers with more complex choices in selecting a vaccine product. This challenge is likely most pressing in countries where rotavirus burden is highest, resources are particularly constrained, and the feasibility of fully assessing and comparing all options is most limited.