Coverage and distributional benefit-cost of rotavirus vaccine in Uganda: an analysis of routine health facility aggregated data
Authors: Kananura Rornald Muhumuza , de Broucker Gatien , Ssebagereka Anthony , Mutebi Aloysius , Kiracho Elizabeth Ekirapa , Patenaude Bryan 
Published: November 2023

Abstract
Introduction
Owing to the lack of local cost and clinical effectiveness data in sub-Saharan Africa, economic evaluations of the rotavirus vaccine are still limited in the region. In this study, we utilize different data sources including aggregated routine health information system data to examine the net benefits of the rotavirus vaccine in Uganda. We also present ways in which health facility data can be used to assess subnational vaccination coverage as well as the effect of the vaccine on diarrhoea hospitalization.
Methods
We used monthly health facility data collected between 2014 and 2021 to study the relationship between rollout of rotavirus vaccine and diarrhoea hospitalization. We gathered information from empirical studies on the cost of diarrhoea (household and health facility) and vaccine administration to estimate the costs averted due to the rotavirus vaccine. As household costs, we considered out-of-pocket payments associated with the episodes of diarrhoea and the productivity loss associated with time spent on treatment and with mortality using a human capital approach. Finally, we employed an interrupted time series analysis to examine the effect of rotavirus vaccine on diarrhoea hospitalization. Costs are presented in 2018 US dollars.
Results
As of 2021, nationwide coverage of the first and second doses of the rotavirus vaccine in Uganda was estimated at 89% and 65% respectively, with variations observed by region. The study revealed a decrease in the incident rate of diarrhoea by 1% for each 1% increase in vaccine coverage. Moreover, the study showed that the incident rate of diarrhoea reduced by 2% for each additional month after the vaccine rollout. Excluding productivity losses due to mortality, the analyses of costs averted due to the vaccine reveal that Uganda has saved approximately $57 million ($7 per capita) in expenses associated with diarrhoea since the vaccine's introduction between 2018 and 2021. The return on investment for the rotavirus immunization program is calculated to be $1.48 per dollar invested. When including mortality costs, the net benefit reached up to $3 billion in economic cost ($385 per capita), and an ROI of $78 overall. Furthermore, the study demonstrated that the rotavirus vaccine provided substantial health benefits, particularly for socially disadvantaged groups. Excluding mortality costs, the ROI for the two most disadvantaged groups ranged from $1.71 to $2.03 per dollar spent, while for the remaining groups, it ranged from $1.10 to $1.14.
Conclusion
This manuscript stresses the importance of the rotavirus vaccine in alleviating the burden of diarrhoeal diseases and associated costs in Uganda. The study not only emphasizes the tangible benefits derived from the vaccine but highlights the role of routine aggregated healthcare information systems in systematically monitoring the effectiveness and coverage of interventions.