Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim

Itamar Megiddo, Abigail R. Colson, Arindam Nandi, Susmita Chatterjee, Shankar Prinja, Ajay Khera, Ramanan Laxminarayan

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases 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. 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], 31.7–37.7) 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, 18.6–25.7) 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. Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.
LanguageEnglish
PagesA151-A161
Number of pages11
JournalVaccine
Volume32
Issue numberSupplement 1
Early online date2 Aug 2014
DOIs
Publication statusPublished - 11 Aug 2014

Fingerprint

Rotavirus Vaccines
Immunization Programs
Rotavirus
India
Immunization
immunization
vaccines
Uncertainty
Health Expenditures
uncertainty
Population
death
Costs and Cost Analysis
rural areas
urban areas
Vaccines
Economics
Vaccine
disability-adjusted life year
Measles Vaccine

Keywords

  • rotavirus vaccine
  • cost benefit analysis
  • cost of illness
  • economics
  • health care cost
  • human
  • India
  • infnat
  • preschool child
  • preventive health service
  • rotavirus infections
  • statistical model
  • vaccination

Cite this

Megiddo, Itamar ; Colson, Abigail R. ; Nandi, Arindam ; Chatterjee, Susmita ; Prinja, Shankar ; Khera, Ajay ; Laxminarayan, Ramanan. / Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim. In: Vaccine. 2014 ; Vol. 32, No. Supplement 1. pp. A151-A161.
@article{f7a8643689e340df9f2ffe0d2024e132,
title = "Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim",
abstract = "India has the highest under-five death toll globally, approximately 20{\%} of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90{\%} randomly across the population. In the third, we evaluate an increase in immunization coverage to 90{\%} through targeted increases 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. 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], 31.7–37.7) 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, 18.6–25.7) 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. Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.",
keywords = "rotavirus vaccine, cost benefit analysis, cost of illness, economics, health care cost, human, India, infnat, preschool child, preventive health service, rotavirus infections, statistical model, vaccination",
author = "Itamar Megiddo and Colson, {Abigail R.} and Arindam Nandi and Susmita Chatterjee and Shankar Prinja and Ajay Khera and Ramanan Laxminarayan",
year = "2014",
month = "8",
day = "11",
doi = "10.1016/j.vaccine.2014.04.080",
language = "English",
volume = "32",
pages = "A151--A161",
journal = "Vaccine",
issn = "0264-410X",
number = "Supplement 1",

}

Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim. / Megiddo, Itamar; Colson, Abigail R.; Nandi, Arindam; Chatterjee, Susmita; Prinja, Shankar; Khera, Ajay; Laxminarayan, Ramanan.

In: Vaccine, Vol. 32, No. Supplement 1, 11.08.2014, p. A151-A161.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Analysis of the universal immunization programme and introduction of a rotavirus vaccine in India with IndiaSim

AU - Megiddo, Itamar

AU - Colson, Abigail R.

AU - Nandi, Arindam

AU - Chatterjee, Susmita

AU - Prinja, Shankar

AU - Khera, Ajay

AU - Laxminarayan, Ramanan

PY - 2014/8/11

Y1 - 2014/8/11

N2 - India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases 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. 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], 31.7–37.7) 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, 18.6–25.7) 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. Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.

AB - India has the highest under-five death toll globally, approximately 20% of which is attributed to vaccine-preventable diseases. India's Universal Immunization Programme (UIP) is working both to increase immunization coverage and to introduce new vaccines. Here, we analyze the disease and financial burden alleviated across India's population (by wealth quintile, rural or urban area, and state) through increasing vaccination rates and introducing a rotavirus vaccine. We use IndiaSim, a simulated agent-based model (ABM) of the Indian population (including socio-economic characteristics and immunization status) and the health system to model three interventions. In the first intervention, a rotavirus vaccine is introduced at the current DPT3 immunization coverage level in India. In the second intervention, coverage of three doses of rotavirus and DPT and one dose of the measles vaccine are increased to 90% randomly across the population. In the third, we evaluate an increase in immunization coverage to 90% through targeted increases 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. 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], 31.7–37.7) 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, 18.6–25.7) 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. Improving immunization coverage and the introduction of a rotavirus vaccine significantly alleviates disease and financial burden in Indian households. Population subgroups or regions with low existing immunization coverage benefit the most from the intervention. Increasing coverage by targeting those subgroups alleviates the burden more than simply increasing coverage in the population at large.

KW - rotavirus vaccine

KW - cost benefit analysis

KW - cost of illness

KW - economics

KW - health care cost

KW - human

KW - India

KW - infnat

KW - preschool child

KW - preventive health service

KW - rotavirus infections

KW - statistical model

KW - vaccination

UR - http://www.sciencedirect.com/science/journal/0264410X

U2 - 10.1016/j.vaccine.2014.04.080

DO - 10.1016/j.vaccine.2014.04.080

M3 - Article

VL - 32

SP - A151-A161

JO - Vaccine

T2 - Vaccine

JF - Vaccine

SN - 0264-410X

IS - Supplement 1

ER -