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Estimated impact and cost-effectiveness of rotavirus vaccination in India: Effects of geographic and economic disparities

机译：印度轮状病毒疫苗接种的估计影响和成本效益：地理和经济差异的影响

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India accounts for 23% of global rotavirus mortality in under-five children, with more than 100,000 deaths from rotavirus annually. Introduction of a vaccine in India is considered to be the most effective intervention for preventing rotavirus mortality. Recent research suggests that there is considerable variation in rotavirus mortality burden across regional, gender and socio-economic subpopulations within India. In addition, there is potential variability in who would likely receive rotavirus vaccine if introduced. We use available household data to estimate heterogeneity in rotavirus mortality risk, vaccination benefits, and cost-effectiveness across geographic and socio-economic groups within India. We account for heterogeneity by modeling estimated three-dose routine vaccinations as a proxy for a generalized rotavirus vaccine, and mortality for subpopulations of children aggregated by region and state, socio-economic status and sex, separately. Results are presented for six geographic regions and for Bihar, Uttar Pradesh, and Madhya Pradesh, three high mortality states accounting for 56% of national mortality estimates. Impact estimates accounting for disparities predict rotavirus vaccine introduction will prevent 35,000 deaths at an average cost of $118/DALY averted (7292 INR/DALY averted). Rotavirus vaccines are most cost-effective for the poor living in high mortality regions and states. Reductions in geographic and socioeconomic disparities based on regional estimates could prevent an additional 9400 deaths annually, while reductions in socio-economic disparities in the three highest morality states alone could prevent an additional 10,600 deaths annually. Understanding the impact of heterogeneity can help improve strategies to maximize the benefits of rotavirus vaccination introduction, leading to fewer lives lost as a result of rotavirus disease
机译：印度占5岁以下儿童全球轮状病毒死亡率的23％，每年轮状病毒死亡人数超过100,000。在印度引入疫苗被认为是预防轮状病毒死亡的最有效干预措施。最近的研究表明，印度内部的轮状病毒死亡率负担在地区，性别和社会经济亚人群中有很大差异。此外，如果引入轮状病毒疫苗，谁可能会接受接种。我们使用现有的家庭数据来估算印度各地域和社会经济群体在轮状病毒死亡风险，疫苗接种收益以及成本效益方面的异质性。我们通过对估计的三剂量常规疫苗接种进行建模（作为通用轮状病毒疫苗的替代品），以及按地区和州，社会经济地位和性别分别汇总的儿童亚群的死亡率，来说明异质性。给出了六个地理区域以及比哈尔邦，北方邦和中央邦的结果，这三个高死亡率国家占全国死亡率估计的56％。考虑到差异的影响估计值预测轮状病毒疫苗的引入将防止35,000例死亡，平均避免平均费用为$ 118 / DALY（避免平均费用为7292 INR / DALY）。轮状病毒疫苗对于高死亡率地区和州的贫困人口而言最具成本效益。根据区域估计，减少地理和社会经济差异，每年可避免9400例死亡，而仅在三个最高道德国家中，社会经济差异的减少可每年防止10600例死亡。了解异质性的影响可以帮助改进策略，以最大程度地提高轮状病毒疫苗接种的收益，从而减少因轮状病毒疾病导致的生命损失

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