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Fulltext The epidemiology and burden of childhood rotavirus infection in a tertiary hospital in Sabah, Malaysia

Goh CT, Cheah PK, Soo TL, Lee WS

Med J Malaysia, 2009 Jun;64(2):146-9.
PMID: 20058575 MyJurnal

We aimed to determine the epidemiology and burden of rotavirus (RV) gastroenteritis (GE) in children requiring hospital care in an urban setting in Sabah, Malaysia. A prospective study of all patients younger than 12 years of age admitted with acute GE to Queen Elizabeth Hospital, Sabah, over a six-month period (October 2005 to March 2006) was conducted. During the study period, a total of 167 children with acute GE who had stool samples examined for RV were studied. RV accounted for 16% of all diarrhoeal cases, and 1.7% of all admissions to the children's wards during the study period. There was no difference in severity of GE between RV and non-RV groups. RV infection is a common cause of childhood GE requiring hospital care in Sabah.

Matched MeSH terms: Rotavirus Infections/economics
Out-of-pocket costs associated with rotavirus gastroenteritis requiring hospitalization in Malaysia

Chai PF, Lee WS

Vaccine, 2009 Nov 20;27 Suppl 5:F112-5.
PMID: 19931708 DOI: 10.1016/j.vaccine.2009.08.069

From August 2006 to July 2007 a prospective study of out-of-pocket costs incurred by care-givers of children hospitalized for rotavirus gastroenteritis was conducted in a hospital in Malaysia. Data on caretaker out-of-pocket costs were collected from 260 children hospitalized with diarrhoea. A stool sample was collected from 198 of these children of which 46 (23%) were positive for rotavirus by latex agglutination assay. The mean (median; interquartile range) out-of-pocket cost incurred by the care-givers was US$194 (US$169; US$47-738), constituting 26% of average monthly income of the households surveyed. Major components of the cost were hospital expenses (45%) and productivity loss (37%). These findings will allow further assessment of the cost-effectiveness of any future rotavirus immunization program in Malaysia.

Matched MeSH terms: Rotavirus Infections/economics*
Estimates of economic burden of providing inpatient care in childhood rotavirus gastroenteritis from Malaysia

Lee WS, Poo MI, Nagaraj S

J Paediatr Child Health, 2007 Dec;43(12):818-25.
PMID: 17608648

To estimate the cost of an episode of inpatient care and the economic burden of hospitalisation for childhood rotavirus gastroenteritis (GE) in Malaysia.

Matched MeSH terms: Rotavirus Infections/economics
The Hidden Health and Economic Burden of Rotavirus Gastroenteritis in Malaysia: An Estimation Using Multiple Data Sources

Loganathan T, Ng CW, Lee WS, Jit M

Pediatr Infect Dis J, 2016 06;35(6):601-6.
PMID: 27008464 DOI: 10.1097/INF.0000000000001129

BACKGROUND: Rotavirus gastroenteritis (RVGE) results in substantial mortality and morbidity worldwide. However, an accurate estimation of the health and economic burden of RVGE in Malaysia covering public, private and home treatment is lacking.
METHODS: Data from multiple sources were used to estimate diarrheal mortality and morbidity according to health service utilization. The proportion of this burden attributable to rotavirus was estimated from a community-based study and a meta-analysis we conducted of primary hospital-based studies. Rotavirus incidence was determined by multiplying acute gastroenteritis incidence with estimates of the proportion of gastroenteritis attributable to rotavirus. The economic burden of rotavirus disease was estimated from the health systems and societal perspective.
RESULTS: Annually, rotavirus results in 27 deaths, 31,000 hospitalizations, 41,000 outpatient visits and 145,000 episodes of home-treated gastroenteritis in Malaysia. We estimate an annual rotavirus incidence of 1 death per 100,000 children and 12 hospitalizations, 16 outpatient clinic visits and 57 home-treated episodes per 1000 children under-5 years. Annually, RVGE is estimated to cost US$ 34 million to the healthcare provider and US$ 50 million to society. Productivity loss contributes almost a third of costs to society. Publicly, privately and home-treated episodes consist of 52%, 27% and 21%, respectively, of the total societal costs.
CONCLUSIONS: RVGE represents a considerable health and economic burden in Malaysia. Much of the burden lies in privately or home-treated episodes and is poorly captured in previous studies. This study provides vital information for future evaluation of cost-effectiveness, which are necessary for policy-making regarding universal vaccination.

Matched MeSH terms: Rotavirus Infections/economics*
Thresholds for decision-making: informing the cost-effectiveness and affordability of rotavirus vaccines in Malaysia

Loganathan T, Ng CW, Lee WS, Hutubessy RCW, Verguet S, Jit M

Health Policy Plan, 2018 Mar 01;33(2):204-214.
PMID: 29228339 DOI: 10.1093/heapol/czx166

Cost-effectiveness thresholds (CETs) based on the Commission on Macroeconomics and Health (CMH) are extensively used in low- and middle-income countries (LMICs) lacking locally defined CETs. These thresholds were originally intended for global and regional prioritization, and do not reflect local context or affordability at the national level, so their value for informing resource allocation decisions has been questioned. Using these thresholds, rotavirus vaccines are widely regarded as cost-effective interventions in LMICs. However, high vaccine prices remain a barrier towards vaccine introduction. This study aims to evaluate the cost-effectiveness, affordability and threshold price of universal rotavirus vaccination at various CETs in Malaysia. Cost-effectiveness of Rotarix and RotaTeq were evaluated using a multi-cohort model. Pan American Health Organization Revolving Fund's vaccine prices were used as tender price, while the recommended retail price for Malaysia was used as market price. We estimate threshold prices defined as prices at which vaccination becomes cost-effective, at various CETs reflecting economic theories of human capital, societal willingness-to-pay and marginal productivity. A budget impact analysis compared programmatic costs with the healthcare budget. At tender prices, both vaccines were cost-saving. At market prices, cost-effectiveness differed with thresholds used. At market price, using 'CMH thresholds', Rotarix programmes were cost-effective and RotaTeq were not cost-effective from the healthcare provider's perspective, while both vaccines were cost-effective from the societal perspective. Using other CETs, both vaccines were not cost-effective at market price, from the healthcare provider's and societal perspectives. At tender and cost-effective prices, rotavirus vaccination cost ∼1 and 3% of the public health budget, respectively. Using locally defined thresholds, rotavirus vaccination is cost-effective at vaccine prices in line with international tenders, but not at market prices. Thresholds representing marginal productivity are likely to be lower than those reflecting human capital and individual preference measures, and may be useful in determining affordable vaccine prices.

Matched MeSH terms: Rotavirus Infections/economics
Fulltext Anticipating rotavirus vaccines--a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13

Alkoshi S, Leshem E, Parashar UD, Dahlui M

BMC Public Health, 2015;15:26.
PMID: 25616973 DOI: 10.1186/s12889-015-1400-7

Libya introduced rotavirus vaccine in October 2013. We examined pre-vaccine incidence of rotavirus hospitalizations and associated economic burden among children < 5 years in Libya to provide baseline data for future vaccine impact evaluations.

Matched MeSH terms: Rotavirus Infections/economics*