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Rotavirus Vaccine & Health Care Utilization for Diarrhea in U.S Children N Engl J Med 2011;365:1108-17 Vanessa Craven Clinical Research Fellow.

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Presentation on theme: "Rotavirus Vaccine & Health Care Utilization for Diarrhea in U.S Children N Engl J Med 2011;365:1108-17 Vanessa Craven Clinical Research Fellow."— Presentation transcript:

1 Rotavirus Vaccine & Health Care Utilization for Diarrhea in U.S Children N Engl J Med 2011;365: Vanessa Craven Clinical Research Fellow

2 Image removed for copyright reasons

3 The Global Picture D&V in < 5yrs 111 million stay at home 25 million clinic visits 2 million hospitalisations deaths Joint Committee on Vaccination & Immunisation statement on rotavirus vaccine; 2008

4 And at Home… episodes hospitalised 3-4 deaths Joint Committee on Vaccination & Immunisation statement on rotavirus vaccine 2008

5 The Vaccines RotarixRotaTeq

6 The Vaccines Rotarix Live attenuated Oral 2 doses £35 per dose 6/52  6/12 No GI symptoms RotaTeq Live attenuated Oral 3 doses £25 per dose 6/52  6/12 ? Mild gut irritation Protection from 5 serotypes (88%) Intussusception & Kawasaki’s disease

7 The UK Stance NOT COST EFFECTIVE

8 What they did… < 5 yrs in U.S Comparison of: –Pre vaccine (01-06) vs Post vaccine (07-09) RV5 = RotaTeq Diarrhoea & specifically rotavirus Heath care use Costs

9 Highest age risk population Vaccine vs no vaccine Outcomes: Health care use (not just hospitals), direct & indirect effects & economics Not vaccine risk or full uptake Large number studied Data available Unvalidated economic tool What data was unavailable or incomplete?

10 Large numbers studied MarketScan database Studied those >6 months (not immunised) but analysed in age groups Medicaid NOT included 1/3 vaccine = immunised Vaccine rates not measured in universal programmes (13 states)

11 Accurate database? Partially vaccinated included Unvalidated vaccine coverage data & economic model RV1 excluded Non blinded Inpatient, ED, outpatient Excluded transition year Included indirect benefits Outcomes: Diarrhoea (all causes) & rotavirus Is rotavirus always tested for, especially if vaccine status is known

12 Only 2 years studied post vaccine Yearly fluctuations Unknown how many children had partial data

13

14 32% vaccinated (73% <1yr) by end of 2008 Hospitalisation RV ↓75% - all ages (07-08) ; ↓60% - proportional to coverage E.g↓26% in 2-4yrs (08-09) Largest effect in <1yr (↓76%) Diarrhoea↓33% (07-08) & ↓25% (08-09) Greatest ↓ during RV season & indirect ED visits ↓9% (07-08) & similar (08-09) except the West OP visits ↓3% (07-08) & similar (08-09) except the West But ED & OP ↑ in in 2-4yrs, Vaccinated vs Unvaccinated 89% ↓RV hospitalisation (small numbers in some regions) 44%/58% ↓Diarrhoea hospitalisation 37%/48% ↓ED 9%/12% ↓OP Similar indirect effect Geographical variation 08-09: $278 million saved

15 Complete dataset? Need more follow up Effect of partial immunisation Economic data Yes! Big effects Incomplete data Important adverse effects data excluded

16 Pre licensure study: ↓59% diarrhoea hospitalisation vaccinated vs unvaccinated Developed country Different vaccination system & healthcare system/approach Low socioeconomic group not included

17 Summary & Conclusions Obvious positive effects –Direct & indirect Adverse effects fully appreciated? Morbidity enough to justify investment?


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