One-way sensitivity analysis was conducted to examine the effects of specific ABT-263 input variables
on vaccination benefit and cost-effectiveness within each geographic area. The results for the impact on the cost-effectiveness ratio are shown in Fig. 4. For all regions, the variables with the greatest impact were vaccine administration cost, rotavirus mortality, and vaccine price, usually in that order. Mortality uncertainty was most important in higher mortality regions. Other variables had limited impact. The sensitivity analysis for vaccination benefit showed that rotavirus mortality accounted for the greatest uncertainty in impact (results not shown). We also examined the effects of specific scenarios on CER: on-time delivery of vaccine doses and uniform medical costs. On-time delivery reduced the CER in all regions (between 3 and 12 $/DALY averted, 185 and 742 INR/DALY averted). Assuming uniform medical treatment costs, resulted in increased CER in regions with higher healthcare utilization and decreased the CER in regions with low utilization. The probabilistic sensitivity analysis was used to estimate uncertainty selleckchem limits around key outcome variables within each geographic region. These are shown in Table 1. A contribution to variance analysis demonstrated that vaccination administration costs and rotavirus mortality uncertainty contributed approximately 50%
and 25% respectively to the overall uncertainty of the CER, and rotavirus mortality contributed over 80% of the overall many uncertainty of the health impact of vaccination. The effect of accounting for disparities in mortality risk and costs can be seen in the comparison to the “Equal Risk” scenario in Table 3. Assuming equal RV mortality risks and treatment costs would result in a 15% overestimation of benefit at a
national level (1.22 vs. 1.44 deaths averted/1000 births). It also would result in an underestimation of the benefits of introducing vaccination in high mortality regions or states and overestimation of the CER in those areas. At a regional level, deaths due to rotavirus are expected to decline by 30–40% in India with the introduction of rotavirus vaccine. Vaccination is estimated to reduce deaths by 23–26% in the states with the highest rotavirus mortality. Among all regions and states evaluated, our current analysis suggests that a vaccination program would be highly cost-effective – consistent with findings of previous analyses [5], [7], [8] and [9]. The greatest potential health benefits of vaccination will come from reaching high rotavirus mortality areas and the poorest households. However, these populations are less likely to benefit given current low coverage estimates. While national vaccination coverage has increased over time in India, further coverage increases in these populations could substantially expand the impact of vaccination.