S108 • JID 2010:202 (Suppl 1) • Berry et al
S U P P L E M E N T A R T I C L E
The Cost-Effectiveness of Rotavirus Vaccination
Stephen A. Berry,1Benjamin Johns,2Chuck Shih,3Andrea A. Berry,4and Damian G. Walker2
1Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Departments of
Management, Johns Hopkins Bloomberg School of Public Health, and
Medicine, Baltimore, Maryland
2International Health and
3Health Policy and
4Center for Vaccine Development, University of Maryland School of
potential to save hundreds of thousands of lives in Africa. Nations such as Malawi, where Rotarix is currently
under phase III investigation, may nevertheless face difficult economic choices in considering vaccine adoption.
The cost-effectiveness of implementing a Rotarix vaccine program in Malawi was estimated using
published estimates of rotavirus burden, vaccine efficacy, and health care utilization and costs.
With 49.5% vaccine efficacy, a Rotarix program could avert 2582 deaths annually. With GAVI Alliance
cofinancing, adoption of Rotarix would be associated with a cost of $5.07 per disability-adjusted life-year averted.
With market pricing, Rotarix would be associated with a base case cost of $74.73 per disability-adjusted life-year
averted. Key variables influencing results were vaccine efficacy, under-2 rotavirus mortality, and program cost of
administering each dose.
Adopting Rotarix would likely be highly cost-effective for Malawi, particularlywithGAVIsupport.
This finding holds true across uncertainty ranges for key variables, including efficacy, for which data are becoming
Rotarix (GlaxoSmithKline), a newly licensed rotavirus vaccine requiring 2 doses, may have the
Rotavirus is one of the top causes of childhood mor-
tality worldwide, leading to 1600,000 annual deaths,
the majority of which are in Africa and Asia . The
virus causes an acute, self-limited febrile gastroenteritis
typically lasting 3–7 days . Since 2006, 2 new vac-
cines, each with at least 80% efficacy against severe
rotavirus-associated disease, have been developed and
licensed by the US Food and Drug Administration .
Rotarix (GlaxoSmithKline), the more recent of these
vaccines, is currently being evaluated in a phase III
study in Malawi and South Africa. Preliminary results
show that efficacy in Malawi may be ∼50% . Unlike
Financial support: National Center for Research Resources (1KL2RR025006-01).
Potential conflicts of interest: none reported.
Supplement sponsorship: This article is part of a supplement entitled “Rotavirus
Infection in Africa: Epidemiology, Burden of Disease, and Strain Diversity,” which
was prepared as a project of the Rotavirus Vaccine Program, a partnership among
PATH, the World Health Organization, and the US Centers for Disease Control and
Prevention, and was funded in full or in part by the GAVI Alliance.
Reprints or correspondence: Dr Stephen A. Berry, Div of Infectious Diseases,
Johns Hopkins School of Medicine, 1830 E Monument St, Ste 457, Baltimore, MD
The Journal of Infectious Diseases
? 2010 by the Infectious Diseases Society of America. All rights reserved.
Rotateq (Merck), Rotarix requires 2 rather than 3 doses
for a full course. This may be particularly important
to developing nations that face difficulty in paying the
program costs of administering vaccines.
This study determined the cost-effectiveness of add-
ing Rotarix to the existing vaccination infrastructure in
Malawi. Malawi is eligible for the highest degree of
support from the GAVI Alliance for cofinancing the
introduction of new vaccines. The GAVI Alliance price
of $0.15 per dose (2008 US dollars) fundamentally
changes the cost-effectiveness profile, compared with
the projected market price of $5.50 (potential range,
$1.00–$10.00) . The goal of the GAVI Alliance is to
provide several years of financial support, with vaccine
costs then gradually transferred to the recipient nation.
This analysis, therefore, examines the cost-effectiveness
of rotavirus vaccination in Malawi with use of both the
subsidized GAVI Alliance price and the market price.
A 2-year time frame was chosen for examining the
disease burden, because a study by Cunliffe et al 
that comprised 11000 Malawian children with hospi-
by guest on December 31, 2015
Malawi Vaccination Cost-Effectiveness • JID 2010:202 (Suppl 1) • S115
34. Comprehensive multi-year plan 2006–2010: Malawi. http://www
.gavialliance.org/performanc/country_results. Accessed 7 May 2009.
35. Vesikari T, Karvonen A, Prymula R, et al. Efficacy of human rotavirus
vaccine against rotavirus gastroenteritis during the first 2 years of life
by guest on December 31, 2015