August 06, 2014
The Question
How would increasing immunization coverage and introducing a rotavirus vaccine affect the disease and financial burden of vaccine-preventable illnesses in India?
What we found
Using IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system, we modeled three interventions: the introduction of a rotavirus vaccine is introduced at the current DPT3 immunization coverage level; the increase in coverage of three doses of rotavirus and DPT and one dose of the measles vaccine to 90% randomly across the population; and the targeted increase of these vaccines to 90% in rural and urban regions (across all states) that are below that level at baseline. For each intervention, we evaluate the disease and financial burden alleviated, costs incurred, and the cost per disability-adjusted life-year (DALY) averted.
Baseline immunization coverage is low and has a large variance across population segments and regions. We determined that targeting specific regions can approximately equate the rural and urban immunization rates. Introducing a rotavirus vaccine at the current DPT3 level (intervention one) averts 34.7 (95% uncertainty range [UR], 31.737.7) deaths and $215,569 (95% UR, $207,846$223,292) out-of-pocket (OOP) expenditure per 100,000 under-five children. Increasing all immunization rates to 90% (intervention two) averts an additional 22.1 (95% UR, 18.625.7) deaths and $45,914 (95% UR, $37,909$53,920) OOP expenditure. Scaling up immunization by targeting regions with low coverage (intervention three) averts a slightly higher number of deaths and OOP expenditure. The reduced burden of rotavirus diarrhea is the primary driver of the estimated health and economic benefits in all intervention scenarios. All three interventions are cost saving.
Why it matters
Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. We have determined that population subgroups or regions with low existing immunization coverage benefit the most from the intervention. This study could therefore inform future interventions by encouraging targeting those subgroups to alleviate the burden rather than simply increasing coverage in the population at large.
