Table 3.
Predicted incremental cost-effectiveness ratios by country adjusted for cost-saving probabilities.
| Country | Predicted ICER adjusted for cost-saving probabilities in 2017 US$ per DALY Averted (95% UI) | Rotavirus Vaccine Efficacy % (95% UI) | Rotavirus diarrhea DALYs per 100,000 children 0 to 5 years of age |
Tufts registry dataset and additional extractions |
||
|---|---|---|---|---|---|---|
| Number of ratios | Minimum ICER in 2017 US$ per DALY or QALY | Maximum ICER in 2017 US$ per DALY or QALY | ||||
| Central Europe Eastern Europe and Central Asia | ||||||
| Albania | 3,373 (523–12,365) |
78 (64–92) |
84.0 | 4 | 446 | 12,964 |
| Armenia | 3,985 (616–14,618) |
79 (65–92) |
52.1 | 16 | 20 | 5,630 |
| Azerbaijan | 2,678 (418–9,830) |
78 (65–92) |
249.5 | 9 | 9 | 100 |
| Belarus | 4,138 (646–15,202) |
84 (73–95) |
62.6 | 2 | 2,989 | 3,626 |
| Bosnia and Herzegovina | 3,166 (493–11,609) |
81 (68–93) |
114.7 | 2 | 6,160 | 6,949 |
| Bulgaria | 3,364 (526–12,393) |
84 (73–95) |
170.7 | 2 | 4,584 | 6,370 |
| Croatia | 8,713 (1,354–32,168) |
85 (75–96) |
105.8 | 0 | NA | NA |
| Czech Republic | 11,215 (1,732–41,604) |
87 (78–96) |
110.0 | 0 | NA | NA |
| Estonia | 13,140 (2,030–48,729) |
87 (79–96) |
55.6 | 0 | NA | NA |
| Georgia | 2,977 (461–10,944) |
80 (67–93) |
52.0 | 10 | 61 | 4,274 |
| Hungary | 10,063 (1,558–37,231) |
85 (75–96) |
89.4 | 0 | NA | NA |
| Kazakhstan | 5,927 (924–21,960) |
81 (69–94) |
87.6 | 2 | 585 | 689 |
| Kyrgyzstan | 499 (75–1,805) |
73 (56–89) |
228.1 | 10 | 22 | 685 |
| Latvia | 9,248 (1,435–34,147) |
87 (78–96) |
93.9 | 0 | NA | NA |
| Lithuania | 8,295 (1,277–30,606) |
88 (79–97) |
134.8 | 0 | NA | NA |
| Macedonia | 2,535 (395–9,279) |
83 (71–94) |
167.0 | 2 | 5,866 | 6,849 |
| Moldova | 1,430 (220–5,199) |
80 (67–93) |
117.3 | 10 | 839 | 5,272 |
| Mongolia | 1,484 (230–5,436) |
72 (55–88) |
368.6 | 10 | 27 | 370 |
| Montenegro | 4,546 (710–16,772) |
85 (74–95) |
64.4 | 0 | NA | NA |
| Poland | 7,712 (1,193–28,438) |
86 (76–96) |
142.1 | 0 | NA | NA |
| Romania | 3,406 (531–12,535) |
83 (72–95) |
248.0 | 2 | 2,163 | 4,570 |
| Russian Federation | 4,410 (682–16,277) |
86 (76–96) |
177.6 | 0 | NA | NA |
| Serbia | 3,531 (552–12,977) |
84 (74–95) |
92.5 | 0 | NA | NA |
| Slovakia | 9,176 (1,415–33,959) |
86 (77–96) |
145.7 | 0 | NA | NA |
| Slovenia | 12,266 (1,898–45,563) |
88 (79–97) |
105.7 | 0 | NA | NA |
| Tajikistan | 175 (26–632) |
66 (48–84) |
3,114.2 | 10 | 2 | 185 |
| Turkmenistan | 3,508 (547–12,919) |
77 (63–92) |
173.1 | 0 | NA | NA |
| Ukraine | 2,058 (316–7,512) |
83 (71–94) |
66.9 | 10 | 1,641 | 4,783 |
| Uzbekistan | 1,131 (173–4,120) |
75 (59–90) |
58.5 | 6 | 1 | 42 |
| High-Income | ||||||
| Andorra | 25,784 (4,010–96,684) |
90 (83–98) |
46.2 | 0 | NA | NA |
| Argentina | 6,742 (1,050–24,866) |
80 (68–93) |
178.9 | 14 | 95 | 21,814 |
| Australia | 40,076 (6,255–149,868) |
88 (79–96) |
36.5 | 11 | 2,765 | 68,147 |
| Austria | 26,603 (4,141–99,919) |
88 (80–97) |
52.5 | 0 | NA | NA |
| Belgium | 24,312 (3,783–91,206) |
88 (80–97) |
58.4 | 61 | 5,630 | 119,778 |
| Brunei | 21,638 (3,358–81,067) |
86 (76–96) |
59.6 | 0 | NA | NA |
| Canada | 36,697 (5,723–138,239) |
89 (81–97) |
27.9 | 14 | 2,078 | 117,187 |
| Chile | 8,156 (1,256–30,162) |
83 (72–95) |
168.2 | 7 | 2,237 | 35,200 |
| Cyprus | 16,771 (2,593–62,496) |
88 (79–96) |
56.0 | 0 | NA | NA |
| Denmark | 19,141 (2,972–71,359) |
90 (82–97) |
141.4 | 0 | NA | NA |
| Finland | 23,096 (3,594–86,609) |
88 (80–97) |
68.2 | 30 | 4,820 | 151,315 |
| France | 22,273 (3,459–83,480) |
88 (79–96) |
65.4 | 46 | 18,843 | 249,924 |
| Germany | 22,090 (3,439–82,722) |
90 (83–98) |
67.7 | 8 | 80,059 | 209,020 |
| Greece | 22,004 (3,401–82,156) |
86 (75–96) |
23.9 | 0 | NA | NA |
| Greenland | 18,586 (2,881–69,232) |
88 (79–96) |
121.7 | 0 | NA | NA |
| Iceland | 27,239 (4,246–102,293) |
89 (81–97) |
47.2 | 0 | NA | NA |
| Ireland | 47,446 (7,397–177,120) |
89 (81–97) |
26.7 | 5 | 59,838 | 206,479 |
| Israel | 22,304 (3,463–83,589) |
86 (76–96) |
54.8 | 12 | 3,284 | 96,391 |
| Italy | 28,493 (4,433–106,974) |
86 (76–96) |
27.8 | 0 | NA | NA |
| Japan | 30,082 (4,686–113,113) |
89 (81–97) |
42.1 | 4 | 7,527 | 85,246 |
| Luxembourg | 46,158 (7,256–169,808) |
90 (82–97) |
50.3 | 0 | NA | NA |
| Malta | 22,324 (3,458–83,507) |
85 (75–96) |
32.9 | 0 | NA | NA |
| Netherlands | 27,239 (4,243–102,313) |
90 (82–97) |
53.1 | 57 | 3,770 | 168,172 |
| New Zealand | 26,123 (4,066–98,009) |
88 (79–97) |
41.0 | 2 | 39,221 | 57,018 |
| Norway | 26,145 (4,093–96,292) |
91 (84–98) |
128.0 | 2 | 51,044 | 56,705 |
| Portugal | 21,739 (3,366–81,290) |
82 (71–94) |
27.6 | 0 | NA | NA |
| Singapore | 29,503 (4,601–110,505) |
89 (81–97) |
55.9 | 0 | NA | NA |
| South Korea | 18,869 (2,914–70,329) |
89 (82–97) |
40.5 | 8 | 107 | 354 |
| Spain | 22,953 (3,566–86,037) |
84 (73–95) |
42.2 | 10 | 26,761 | 319,574 |
| Sweden | 25,135 (3,921–93,656) |
90 (82–97) |
80.6 | 0 | NA | NA |
| Switzerland | 28,464 (4,461–105,356) |
92 (85–98) |
91.5 | 0 | NA | NA |
| United Kingdom | 45,242 (7,052–170,512) |
89 (81–97) |
11.7 | 44 | 39,730 | 189,763 |
| Uruguay | 7,965 (1,226–29,489) |
79 (66–93) |
182.6 | 2 | 1,470 | 1,525 |
| United States | 70,599 (11,030–263,858) |
89 (80–97) |
45.5 | 2 | 121,302 | 223,843 |
| Latin America and Caribbean | ||||||
| Antigua and Barbuda | 8,119 (1,261–29,994) |
82 (70–94) |
130.7 | 0 | NA | NA |
| Barbados | 10,691 (1,655–39,635) |
82 (70–94) |
86.5 | 0 | NA | NA |
| Belize | 1,465 (227–5,379) |
72 (56–89) |
310.5 | 2 | 544 | 621 |
| Bermuda | 38,801 (6,085–144,020) |
87 (77–96) |
54.6 | 0 | NA | NA |
| Bolivia | 960 (147–3,508) |
69 (51–86) |
562.1 | 10 | 25 | 388 |
| Brazil | 2,848 (439–10,582) |
75 (59–90) |
277.7 | 9 | 856 | 7,223 |
| Colombia | 2,279 (354–8,427) |
74 (58–90) |
245.8 | 4 | 892 | 2,461 |
| Costa Rica | 2,892 (450–10,714) |
78 (64–92) |
183.8 | 2 | 5,186 | 5,313 |
| Cuba | 3,183 (495–11,752) |
77 (62–91) |
72.9 | 8 | 6,674 | 17,604 |
| Dominica | 1,7008 (265–6,246) |
82 (70–94) |
276.8 | 0 | NA | NA |
| Dominican Republic | 1,930 (300–7,129) |
71 (54–88) |
367.4 | 7 | 494 | 1,036 |
| Ecuador | 2,084 (323–7,672) |
75 (59–90) |
163.1 | 0 | NA | NA |
| El Salvador | 1,332 (205–4,879) |
69 (51–86) |
377.8 | 0 | NA | NA |
| Grenada | 3,361 (523–12,448) |
77 (62–92) |
99.4 | 0 | NA | NA |
| Guatemala | 603 (93–2,191) |
63 (44–82) |
2,533.1 | 2 | 662 | 906 |
| Guyana | 982 (152–3,590) |
73 (57–89) |
741.3 | 10 | 3 | 2,973 |
| Haiti | 224 (345–807) |
55 (34–75) |
2,110.5 | 10 | 2 | 174 |
| Honduras | 980 (149–3,562) |
62 (42–81) |
598.4 | 15 | 51 | 1,089 |
| Jamaica | 2,223 (345–8,170) |
78 (64–92) |
110.3 | 2 | 925 | 925 |
| Mexico | 2,742 (426–10,168) |
76 (61–91) |
230.1 | 10 | 589 | 3,232 |
| Nicaragua | 586 (89–2,108) |
64 (45–83) |
330.7 | 10 | 100 | 1,106 |
| Panama | 4,317 (665–15,877) |
78 (64–92) |
531.2 | 7 | 70 | 3,295 |
| Paraguay | 1,975 (305–7,259) |
75 (60–90) |
144.2 | 2 | 1,477 | 1,615 |
| Peru | 3,464 (538–12,765) |
75 (60–91) |
62.0 | 20 | 132 | 2,438 |
| Puerto Rico | 16,041 (2,482–59,786) |
87 (77–96) |
64.8 | 0 | NA | NA |
| Saint Lucia | 2,774 (432–10,261) |
77 (62–92) |
144.9 | 2 | 2,567 | 2,568 |
| Saint Vincent and the Grenadines | 2,006 (312–7,382) |
73 (57–89) |
247.2 | 0 | NA | NA |
| Suriname | 1,441 (224–5,299) |
75 (59–90) |
536.4 | 0 | NA | NA |
| The Bahamas | 13,998 (2,167–52,117) |
86 (76–96) |
89.4 | 0 | NA | NA |
| Trinidad and Tobago | 8,415 (1,296–31,129) |
84 (73–95) |
165.3 | 0 | NA | NA |
| Venezuela | 1,485 (231–5,467) |
74 (58–90) |
575.2 | 5 | 622 | 1,540 |
| Virgin Islands | 18,944 (2,936–70,770) |
87 (77–96) |
54.1 | 0 | NA | NA |
| North Africa and Middle East | ||||||
| Afghanistan | 221 (33–790) |
42 (21–64) |
3,324.8 | 13 | 5 | 82 |
| Algeria | 2,579 (401–9,461) |
76 (61–91) |
218.5 | 2 | 828 | 1,070 |
| Bahrain | 14,100 (2,180–52,529) |
84 (72–95) |
82.7 | 0 | NA | NA |
| Egypt | 553 (85–2,002) |
74 (59–90) |
1,646.9 | 3 | 424 | 553 |
| Iran | 2,916 (455–10,725) |
78 (64–92) |
300.9 | 10 | 3 | 10,224 |
| Iraq | 2,488 (387–9,129) |
75 (60–90) |
301.2 | 2 | 219 | 270 |
| Jordan | 2,069 (320–7,536) |
80 (67–93) |
196.8 | 2 | 1,842 | 1,873 |
| Kuwait | 14,899 (2,319–55,585) |
88 (79–96) |
130.2 | 0 | NA | NA |
| Lebanon | 3,109 (485–11,432) |
79 (65–93) |
225.1 | 0 | NA | NA |
| Libya | 2,907 (454–10,668) |
81 (69–94) |
146.2 | 1 | 8,411 | 8,411 |
| Morocco | 1,019 (157–3,717) |
66 (48–84) |
711.8 | 2 | 672 | 871 |
| Oman | 7,255 (1,120–26,810) |
84 (73–95) |
244.8 | 1 | 2,462 | 2,462 |
| Palestine | 1,772 (273–6,426) |
67 (49–85) |
137.0 | 0 | NA | NA |
| Qatar | 33,499 (5,241–124,349) |
88 (79–96) |
61.1 | 0 | NA | NA |
| Saudi Arabia | 9,400 (1,455–34,840) |
86 (76–96) |
184.2 | 0 | NA | NA |
| Sudan | 303 (46–1,101) |
62 (43–82) |
2,206.7 | 10 | 62 | 316 |
| Syria | 694 (105–2,508) |
73 (57–89) |
118.3 | 2 | 720 | 753 |
| Tunisia | 2,178 (337–8,000) |
77 (63–92) |
117.2 | 2 | 1,387 | 1,412 |
| Turkey | 6,660 (1,034–24,757) |
79 (66–93) |
92.8 | 2 | 596 | 1,319 |
| United Arab Emirates | 17,361 (2,704–64,889) |
89 (81–97) |
112.6 | 0 | NA | NA |
| Yemen | 158 (24–568) |
56 (36–76) |
4,085.9 | 10 | 18 | 408 |
| South Asia | ||||||
| Bangladesh | 343 (52–1,235) |
59 (40–79) |
829.8 | 19 | 23 | 1,543 |
| Bhutan | 1,780 (273–6,467) |
57 (37–77) |
236.1 | 10 | 15 | 280 |
| India | 260 (40–945) |
67 (49–85) |
1,981.5 | 29 | 17 | 294 |
| Nepal | 530 (80–1,910) |
53 (32–74) |
298.7 | 10 | 23 | 776 |
| Pakistan | 392 (59–1,408) |
56 (35–76) |
791.4 | 15 | 15 | 371 |
| Southeast Asia East Asia and Oceania | ||||||
| American Samoa | 3,435 (536–12,634) |
82 (69–94) |
195.0 | 0 | NA | NA |
| Cambodia | 345 (52–1,240) |
59 (39–79) |
869.3 | 9 | 1 | 99 |
| China | 3,301 (515–12,134) |
79 (66–93) |
173.9 | 35 | 688 | 213,789 |
| Federated States of Micronesia | 1,568 (240–5,722) |
70 (53–87) |
192.0 | 2 | 960 | 1,057 |
| Fiji | 1,484 (231–5,430) |
77 (62–91) |
692.1 | 2 | 1,971 | 2,179 |
| Guam | 10,513 (1,638–39,079) |
87 (77–96) |
236.8 | 0 | NA | NA |
| Indonesia | 629 (98–2,287) |
75 (60–91) |
2,402.1 | 13 | 30 | 468 |
| Kiribati | 672 (102–2,447) |
65 (46–83) |
1,121.5 | 8 | 4 | 153 |
| Laos | 182 (28–657) |
61 (41–80) |
5,772.2 | 10 | 6 | 111 |
| Malaysia | 4,885 (762–18,060) |
82 (69–94) |
127.7 | 2 | 2,488 | 2,899 |
| Maldives | 4,641 (721–17,186) |
73 (57–89) |
127.7 | 2 | 19,039 | 23,812 |
| Marshall Islands | 2,289 (352–8,393) |
67 (49–85) |
225.3 | 0 | NA | NA |
| Mauritius | 3,493 (544–12,879) |
80 (67–93) |
264.7 | 1 | 418,802 | 418,802 |
| Myanmar | 251 (38–907) |
63 (44–82) |
2,107.3 | 10 | 7 | 238 |
| North Korea | 306 (46–1,103) |
68 (50–86) |
741.2 | 0 | NA | NA |
| Northern Mariana Islands | 8,104 (1,250–29,962) |
85 (75–96) |
183.9 | 0 | NA | NA |
| Papua New Guinea | 331 (50–1,196) |
54 (33–74) |
2,501.9 | 8 | 20 | 181 |
| Philippines | 719 (111–2,615) |
72 (56–89) |
1,221.6 | 2 | 404 | 446 |
| Samoa | 2,346 (363–8,580) |
75 (60–91) |
196.7 | 2 | 1,527 | 1,698 |
| Seychelles | 7,870 (1,223–29,077) |
81 (69–94) |
140.7 | 0 | NA | NA |
| Solomon Islands | 480 (73–1,729) |
53 (32–73) |
662.8 | 10 | 168 | 990 |
| Sri Lanka | 2,419 (373–8,872) |
79 (66–93) |
70.7 | 10 | 190 | 4,144 |
| Taiwan (Province Of China) | 11,185 (1,728–41,464) |
89 (81–97) |
109.3 | 5 | 308 | 7,903 |
| Thailand | 2,483 (387–9,102) |
77 (63–92) |
293.7 | 3 | 126 | 4,335 |
| Timor-Leste | 722 (111–2,620) |
64 (46–83) |
1,617.6 | 10 | 19 | 302 |
| Tonga | 2,577 (400–9,441) |
75 (60–90) |
187.2 | 2 | 2,869 | 3,170 |
| Vanuatu | 1,047 (160–3,802) |
61 (41–80) |
768.7 | 2 | 2,878 | 3,254 |
| Vietnam | 1,227 (189–4,464) |
73 (57 89) |
205.3 | 29 | 82 | 3,548 |
| Sub-Saharan Africa | ||||||
| Angola | 566 (88–2,057) |
58 (38–78) |
5,893.8 | 8 | 0 | 107 |
| Benin | 165 (25–589) |
45 (24–66) |
6,770.6 | 10 | 11 | 134 |
| Botswana | 1,217 (189–4,452) |
74 (59–90) |
2,682.2 | 2 | 298 | 459 |
| Burkina Faso | 148 (22–525) |
37 (17–57) |
10,865.4 | 10 | 9 | 99 |
| Burundi | 187 (28–667) |
40 (19–60) |
3,689.4 | 10 | 11 | 103 |
| Cameroon | 180 (27–650) |
58 (39–78) |
4,953.5 | 10 | 10 | 87 |
| Cape Verde | 1,298 (199–4,723) |
63 (44–82) |
492.2 | 2 | 1,041 | 1,373 |
| Central African Republic | 85 (13–302) |
40 (20–61) |
27,445.5 | 10 | 14 | 117 |
| Chad | 120 (18–428) |
33 (14–52) |
23,156.9 | 9 | 7 | 47 |
| Comoros | 206 (31–744) |
59 (40–79) |
2,673.6 | 10 | 71 | 210 |
| Congo (Brazzaville) | 209 (32–757) |
68 (50–86) |
4,290.1 | 11 | 17 | 149 |
| Cote D'Ivoire | 201 (31–722) |
51 (30–72) |
5,289.2 | 10 | 10 | 184 |
| Djibouti | 310 (47–1,118) |
54 (34–75) |
1,768.6 | 7 | 17 | 121 |
| DR Congo | 124 (19–443) |
47 (26–68) |
9,297.0 | 10 | 15 | 106 |
| Equatorial Guinea | 1,714 (267–6,306) |
76 (61–91) |
2,480.6 | 0 | NA | NA |
| Eritrea | 168 (263–602) |
52 (31–73) |
4,185.5 | 10 | 72 | 635 |
| Ethiopia | 192 (29–686) |
44 (23–66) |
3,995.0 | 11 | 13 | 145 |
| Gabon | 1,438 (223–5,279) |
74 (58–90) |
2,426.4 | 0 | NA | NA |
| Ghana | 207 (32–750) |
67 (50–85) |
3147.3 | 17 | 2 | 519 |
| Guinea | 182 (28–659) |
42 (21–63) |
5116.5 | 10 | 8 | 80 |
| Guinea-Bissau | 142 (225–507) |
46 (24–67) |
8,414.6 | 10 | 4 | 70 |
| Kenya | 207 (31–749) |
62 (42–81) |
2,547.8 | 25 | 22 | 553 |
| Lesotho | 184 (28–665) |
62 (43–82) |
4,207.3 | 10 | 184 | 790 |
| Liberia | 167 (25–595) |
46 (25–68) |
4,966.2 | 10 | 10 | 144 |
| Madagascar | 164 (25–586) |
48 (27–69) |
4,728.8 | 10 | 7 | 206 |
| Malawi | 221 (33–796) |
48 (27–69) |
2,354.5 | 25 | 2 | 194 |
| Mali | 296 (45–1,056) |
37 (17–57) |
2,326.7 | 10 | 2 | 60 |
| Mauritania | 215 (33–776) |
60 (41–80) |
3,046.7 | 10 | 8 | 75 |
| Mozambique | 254 (38–911) |
41 (20–62) |
2,327.8 | 10 | 13 | 98 |
| Namibia | 1,265 (197–4,623) |
72 (55–88) |
1,643.8 | 2 | 650 | 819 |
| Niger | 166 (25–588) |
24 (8–41) |
10,655.5 | 10 | 5 | 63 |
| Nigeria | 133 (20–479) |
62 (43–81) |
14,002.9 | 11 | 1 | 74 |
| Rwanda | 185 (28–664) |
54 (33–74) |
3,653.4 | 10 | 0 | 127 |
| Sao Tome and Principe | 349 (52–1,238) |
60 (40–80) |
902.0 | 10 | 27 | 385 |
| Senegal | 210 (32–753) |
51 (30–71) |
3,732.1 | 24 | 15 | 174 |
| Sierra Leone | 167 (25–593) |
44 (23–65) |
5,362.5 | 10 | 1 | 71 |
| Somalia | 168 (25–592) |
21 (6–36) |
7,146.1 | 10 | 4 | 30 |
| South Africa | 1,575 (246–5,758) |
78 (64–92) |
1,114.7 | 2 | 124 | 186 |
| South Sudan | 151 (23–540) |
40 (19–61) |
14,259.4 | 0 | NA | NA |
| Swaziland | 467 (73–1,699) |
69 (52–87) |
5,669.8 | 2 | 222 | 302 |
| Tanzania | 370 (56–1,331) |
52 (31–73) |
790.3 | 11 | 16 | 160 |
| The Gambia | 332 (50–1,199) |
50 (30–71) |
836.8 | 10 | 20 | 160 |
| Togo | 153 (23–548) |
51 (30–72) |
5,594.9 | 10 | 20 | 216 |
| Uganda | 218 (33–783) |
50 (29–71) |
2,580.0 | 13 | 11 | 80 |
| Zambia | 234 (36–844) |
60 (41–80) |
2,967.4 | 10 | 10 | 118 |
| Zimbabwe | 197 (30–709) |
59 (39–79) |
2,773.1 | 8 | 18 | 246 |
Country predictions assuming 90% vaccine coverage, lifetime time horizon, payer perspective, 3% cost and burden discount rates, monovalent vaccine type, DALYs averted as health outcome measure, vaccine cost (for 2-dose course) and no intervention as the comparator. ICER = incremental cost-effectiveness ratio, UI = uncertainty interval, QALY = quality-adjusted life-year, DALY = disability adjusted life-year.