Introduction:

Rotavirus is one of the most common cause of severe gastroenteritis in children, with the largest mortality burden in low- and middle-income countries. To prevent rotavirus gastroenteritis, Mozambique introduced ROTARIX vaccine in 2015, however, its cost-effectiveness has never been established in the country. In 2018, additional vaccines became available globally. This study estimates the cost-effectiveness of the recently introduced ROTARIX in Mozambique and compares the cost effectiveness of ROTARIX , ROTAVAC , and ROTASIIL to inform future use.

Methods:

We used a decision-support model to calculate the potential cost-effectiveness of vaccination with ROTARIX compared to no vaccination over a five-year period (2016–2020) and to compare the cost-effectiveness of ROTARIX, ROTAVAC, and ROTASIIL to no vaccination and to each other over a ten year period (2021–2030). The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted from a government perspective. We assessed uncertainty through sensitivity analy ses.

Results:

From 2016 to 2020, we estimate the vaccine program with ROTARIX cost US$12.3 million, pre vented 4,628 deaths, and averted US$3.1 million in healthcare costs. The cost per DALY averted was US $70. From 2021 to 2030, we estimate all three vaccines could prevent 9,000 deaths and avert US$7.8 mil lion in healthcare costs. With Global Alliance for Vaccines and Immunization (Gavi) support, ROTARIX would have the lowest vaccine program cost (US$31 million) and 98 % probability of being cost effective at a willingness-to-pay threshold of 0.5x GDP per capita. Without Gavi support, ROTASIIL would have the lowest vaccine program cost (US$75.8 million) and 30 % probability of being cost-effective at the same threshold.

Conclusion:

ROTARIX vaccination had a substantial public health impact in Mozambique between 2016 and 2020. ROTARIX is currently estimated to be the most cost-effective product, but the choice of vaccine should be re-evaluated as more evidence emerges on the price, incremental delivery cost, wastage, and impact associated with each of the different rotavirus vaccines.