Cost effectiveness analysis of rotavirus vaccination in Indonesia

Background: Rotavirus (RV) remains the most common cause of morbidity and mortality due to acute gastroenteritis (AGE) in children under five. In Indonesia, RV is responsible for 60 % of severe AGE and 40 % of nonsevere AGE in these children. This study assessed the cost-effectiveness of introduction of rotavirus vaccines (RVV) into the National Immunization Program in Indonesia.
Methods: We conducted a cost-effectiveness analysis (CEA) of RVV introduction in Indonesia, assuming a threedose vaccine schedule based on the planned introduction proposed by the Strategic Advisory Group of Experts on Immunization. The analysis involved an initial introduction of an imported RVV (Rotavac®, Bharat Biotech, India) followed by a staged implementation of the locally produced RVV (Bio Farma, Indonesia) from both health system and societal perspectives. The primary outcome measure was the incremental cost (2019 USD) per disability-adjusted life year (DALY) averted, compared to no vaccination. We took model inputs from an Indonesian cost-of-illness study, national information systems and scientific literature, covering disease incidence, hospitalization, mortality, healthcare costs, and vaccine related factors. Our analyses included univariate and probabilitistic sensitivity analyses to assess various parameters.
Findings: The cost of a 10-year vaccination program is 82.6 million USD and can potentially prevent 7.3 million
cases of rotavirus and 0.42 million DALYs. From a societal perspective, the incremental cost-effectiveness ratio
(ICER) for the staged program is 464 USD per DALY averted (12 % of Indonesia’s gross domestic product (GDP)
per capita). From a healthcare sector perspective, ICER is similar at 479 USD (13 % GDP per capita).
Interpretation: The introduction of RVV into the National Immunization Program is likely to be highly costeffective in Indonesia.

Funding: This work was supported by funding agreement with the Murdoch Children’s Research Institute (MCRI),
PATH, and the Indonesian Technical Advisory Group on Immunization (ITAGI).