In several analyses, both the healthcare payer and societal perspectives were used,[33–40] whereas other studies were conducted from either a societal[41,42] or a healthcare payer

perspective.[43] EPZ 6438 Two studies adopted a ‘limited societal’ perspective, which excluded indirect costs but included out-of-pocket medical expenses along with other direct medical costs.[44,45] Some studies focused only on RIX4414,[36,37,42–44] while others also included indirect comparisons with the pentavalent rotavirus vaccine[34,35,38,39,41,45] or, in some cases, the universal rotavirus vaccination program being evaluated allowed for the use of either RIX4414 or the pentavalent rotavirus vaccine.[33,40,45] A wide range of results was reported across the cost-effectiveness analyses, which appears to be related, at least in part, to the substantial heterogeneity among the models used in the studies. The analyses typically showed that the cost of a universal rotavirus vaccination program was partly offset by reductions in RVGE-related healthcare resource use and that the program was associated with quality-adjusted life-year (QALY) gains. However, the universal rotavirus vaccination program was deemed to be cost effective from the perspective of the healthcare payer only in some studies,[36,37,42,43] but not in others,[33–35,38–40,43]

when applying commonly reported cost-effectiveness thresholds, such as €20 000–50

000, $US50 GDC-0973 supplier 000, or £20 000–30 000 per QALY gained.[46–49] A consistent finding across studies that were conducted from both a healthcare payer and a societal (or ‘limited societal’) perspective was that incremental cost-effectiveness ratios (ICERs) were more favorable from a societal perspective,[33–40,43] as might be expected because additional costs associated with RVGE (e.g. out-of-pocket medical expenses and/or lost productivity of parents of children who develop RVGE) were included. Another consistent finding of the studies was that, compared with no universal vaccination program, ICER values for a two-dose oral series Phospholipase D1 of rotavirus vaccine RIX4414 were more favorable than those for a three-dose oral series of pentavalent rotavirus vaccine when cost effectiveness of the two vaccines was evaluated separately in the same study.[34,35,38,39,41,45] However, modelled analyses directly comparing the two vaccines would require head-to-head clinical trial data, which are currently lacking. In addition, there are inherent uncertainties in comparing ICER values of the available rotavirus vaccines because of the tender process that would be used to establish the vaccine price in a universal program. Although results of the cost-effectiveness analyses were sensitive to a number of parameters, which often varied between studies, there were also some common findings in the sensitivity analyses.