Online Resource 5

Table 1: Description of articles included in review

# / First Author / Year of publication / Title / Type of Article / Country / World Bank Income Classification
1 / Bar-Zeev [1] / 2016 / Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient-Level Costing Data. / CEA / Malawi / L
2 / Cui [2] / 2016 / Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option / CEA / China / UM
3 / Koksal [3] / 2016 / Cost-effectiveness of rotavirus vaccination in Turkey / CEA / Turkey / UM
4 / Mousavi Jarrahi [4] / 2016 / The cost effectiveness of rotavirus vaccination in Iran. / CEA / Iran / UM
5 / Sun [5] / 2016 / A cost-effectiveness analysis on universal infant rotavirus vaccination strategy in China / CEA / China / UM
6 / Ahmeti [6] / 2015 / Cost effectiveness of rotavirus vaccination in Albania / CEA / Albania / UM
7 / Diop [7] / 2015 / Estimated impact and cost-effectiveness of rotavirus vaccination in Senegal: A country-led analysis / CEA / Senegal / LM
8 / Gargano [8] / 2015 / Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study / CEA / Somalia / L
9 / Javanbakht [9] / 2015 / Cost-effectiveness analysis of introduction of the rotavirus vaccine in Iran / CEA / Iran / UM
10 / Marti [10] / 2015 / Cost effectiveness evaluation of a rotavirus vaccination program in Argentina / CEA / Argentina / UM
11 / Paternina-Caicedo [11] / 2015 / Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-effectiveness Modeling Analysis / CEA / 116 low and middle income countries across all regions of the world / various
12 / Pecenka [12] / 2015 / Health gains and financial risk protection: an extended cost-effectiveness analysis of treatment and prevention of diarrhoea in Ethiopia / CEA / Ethiopia / L
13 / Ruhago [13] / 2015 / Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania / CEA / Tanzania / L
14 / Shakerian [14] / 2015 / Cost-effectiveness of rotavirus vaccination for under-five children in Iran / CEA / Iran / UM
15 / Sigei [15] / 2015 / Cost effectiveness of rotavirus vaccination in Kenya and Uganda / CEA / Kenya and Uganda / L and L
16 / Uruena [16] / 2015 / Cost-effectiveness analysis of rotavirus vaccination in Argentina / CEA / Argentina / UM
17 / Verguet [17] / 2015 / Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: An extended cost-effectiveness analysis / CEA / Ethiopia / L
18 / Alkoshi [18] / 2014 / Cost-effectiveness analysis of rotavirus vaccination among Libyan children using a simple economic model / CEA / Libya / UM
19 / Freiesleben de Blasio [19] / 2014 / Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan / CEA / Kazakhstan / UM
20 / John [20] / 2014 / Rotavirus gastroenteritis in India, 2011-2013: revised estimates of disease burden and potential impact of vaccines / CEA / India / LM
21 / Megiddo [21] / 2014 / Analysis of the Universal Immunization Programme and introduction of a rotavirus vaccine in India with IndiaSim / CEA / India / LM
22 / Rheingans [22] / 2014 / Estimated Impact and cost-effectiveness of rotavirus vaccination in India: Effects of geographic and economic disparities. / CEA / India / LM
23 / Hacimustafaoglu [23] / 2013 / Cost effectiveness of both (Monovalent and Pentavalent) rotavirus vaccines / CEA / Turkey / UM
24 / Patel [24] / 2013 / Cost-effectiveness of a new rotavirus vaccination program in Pakistan: a decision tree model / CEA / Pakistan / LM
25 / Suwantika [25] / 2013a / Cost-effectiveness of rotavirus immunization in Indonesia: taking breastfeeding patterns into account / BIA conducted alongside CEA / Indonesia / LM
26 / Suwantika [26] / 2013b / Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia / BIA conducted alongside CEA / Indonesia / LM
27 / Verguet [27] / 2013 / Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis / CEA / India and Ethiopia / LM and L
28 / Abbott [28] / 2012 / Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Ghana / CEA / Ghana / LM
29 / Atherly [29] / 2012 / Projected health and economic impact of rotavirus vaccination in GAVI-eligible countries: 2011-2030 / CEA / 72 GAVI-eligible countries across all WHO regions / various
30 / Liu [30] / 2012 / Projected health impact and cost-effectiveness of rotavirus vaccination among children <5 years of age in China. / CEA / China / UM
31 / Muangchana [31] / 2012 / Economic analysis for evidence-based policy-making on a national immunization program: a case of rotavirus vaccine in Thailand. / BIA conducted alongside CEA / Thailand / UM
32 / Rheingans [32] / 2012 / Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness. / CEA / 25 GAVI eligible countries / various
33 / Tu [33] / 2012 / Health economics of rotavirus immunization in Vietnam: potentials for favorable cost-effectiveness in developing countries / CEA / Vietnam / LM
34 / van Hoek [34] / 2012 / A cost effectiveness and capacity analysis for the introduction of universal rotavirus vaccination in Kenya: comparison between Rotarix and RotaTeq vaccines / CEA / Kenya / L
35 / Esposito [35] / 2011 / Projected impact and cost- effectiveness of a rotavirus vaccination program in India / CEA / India / LM
36 / Jit [36] / 2011 / The cost-effectiveness of rotavirus vaccination in Armenia / BIA conducted alongside CEA / Armenia / LM
37 / Kim [37] / 2011 / Comparative evaluation of the potential impact of rotavirus versus HPV vaccination in GAVI-eligible countries: a preliminary analysis focused on the relative disease burden / CEA / 72 GAVI-eligible countries across all WHO regions / various
38 / Smith [38] / 2011 / Cost-effectiveness of rotavirus vaccination in Bolivia from the state perspective / CEA / Bolivia / LM
39 / Tate [39] / 2011 / Projected health benefits and costs of pneumococcal and rotavirus vaccination in Uganda / CEA / Uganda / L
40 / Berry [40] / 2010 / The Cost-effectiveness of Rotavirus Vaccination in Malawi / CEA / Malawi / L
41 / Centenari [41] / 2010 / Rotavirus vaccination in northeast Brazil: A laudable intervention, but can it lead to cost-savings? / BIA / Brazil / UM
42 / Chotivitayatarakorn [42] / 2010 / Cost-effectiveness of Rotavirus vaccination as part of the national immunization program for Thai children / CEA / Thailand / LM
43 / De la Hoz [43] / 2010 / Potential epidemiological and economical impact of two rotavirus vaccines in Colombia / CEA / Colombia / UM
44 / Kim [44] / 2010 / Health and economic impact of rotavirus vaccination in GAVI-eligible countries / BIA conducted alongside CEA / 72 GAVI-eligible countries across all WHO regions / various
45 / Atherly [45] / 2009 / Rotavirus Vaccination: Cost-effectiveness and Impact on Child Mortality in Developing Countries / CEA / 72 GAVI-eligible countries across all WHO regions / various
46 / Chandrasena [46] / 2009 / Hospital-based study of the severity and economic burden associated with rotavirus diarrhea in Sri Lanka / CEA / Sri Lanka / LM
47 / Clark [47] / 2009 / Cost-effectiveness of rotavirus vaccination in Peru / CEA / Peru / LM
48 / Constenla [48] / 2009 / Economic impact of a rotavirus vaccination program in Mexico / CEA / Mexico / UM
49 / Flem [49] / 2009 / Costs of diarrheal disease and the cost-effectiveness of a rotavirus vaccination program in Kyrgyzstan / CEA / Kyrgyzstan / L
50 / Kim [50] / 2009 / Cost-effectiveness of rotavirus vaccination in Vietnam / CEA / Vietnam / L
51 / Ortega [51] / 2009 / Cost–benefit analysis of a rotavirus immunization program in the Arab Republic of Egypt / CEA / Arab Republic of Egypt / LM
52 / Rheingans [52] / 2009 / Economic costs of rotavirus gastroenteritis and cost effectiveness of vaccination in developing countries / CEA / Regional groups used by WHO / various
53 / Rose [53] / 2009 / Public health impact and cost effectiveness of mass vaccination with live attenuated human rotavirus vaccine in India: model based analysis / CEA / India / LM
54 / Tate [54] / 2009 / Rotavirus disease burden and impact and cost-effectiveness of a rotavirus vaccination program in Kenya / CEA / Kenya / L
55 / Wang [55] / 2009 / Potential cost-effectiveness of a rotavirus immunization program in rural China / CEA / China / LM
56 / Wilopo [56] / 2009 / Economic evaluation of a routine rotavirus vaccination programme in Indonesia / CEA / Indonesia / LM
57 / Constenla [57] / 2008 / Economic impact of a rotavirus vaccine in Brazil / CEA / Brazil / UM
58 / Constenla [58] / 2008 / Economic impact of rotavirus vaccination in Panama / CEA / Panama / UM
59 / De Soárez [59] / 2008 / Cost-effectiveness analysis of routine rotavirus vaccination in Brazil / CEA / Brazil / UM
60 / Valencia-Mendoza [60] / 2008 / Cost-effectiveness of introducing a rotavirus vaccine in developing countries: the case of Mexico / CEA / Mexico / UM
61 / Isakbaeva [61] / 2007 / Rotavirus disease in Uzbekistan: cost-effectiveness of a new vaccine / CEA / Uzbekistan / L
62 / Rheingans [62] / 2007 / Potential cost-effectiveness of vaccination for rotavirus gastroenteritis in eight Latin American and Caribbean countries / CEA / Argentina, Brazil, Chile, The Dominican Republic, Honduras, Mexico, Panama, and Venezuela / various
63 / Constenla [63] / 2006 / Assessment of the economic impact of the antiretroviral vaccine in Venezuela / CEA / Venezuela / UM
64 / Constenla [64] / 2006 / Potential cost effectiveness of a rotavirus vaccine in Chile / CEA / Chile / UM
65 / Fischer [65] / 2005 / Health care costs of diarrheal disease and estimates of the cost-effectiveness of rotavirus vaccination in Vietnam / CEA / Vietnam / L
66 / Podewils [66] / 2005 / Projected cost-effectiveness of rotavirus vaccination for children in Asia / CEA / Southeast Asian and Western Pacific regions of the WHO, excluding Australia and New Zealand / various

Notes: CEA = Cost-effectivenesss analysis; BIA = Budget impact analysis; L = Low income country; LM = Lower middle income country; UM = Upper middle income country.

a World Bank Analytical Classification using GNI per capita in US$ (Atlas methodology), based on World Bank’s fiscal year at the time of publication

Table 2: BIA Checklist Data Extraction

Item # / BIA Checklist Item / Detailed Data Extraction to inform BIA Checklist Score
Suwantika 2013a
1 / Setting / (4/5) Financing: Potential GAVI support for rotavirus immunization, in future Indonesian government should finance vaccination by itself; Budget: Gives total UIP budget; Decision: Specifies vaccine has not been introduced; Disease: prospective surveillance in 2006 showed that rotavirus infections were responsible for the majority of severe diarrhea in children under-5-years; Health care system: N/A
2 / Study Perspective / Health Care Provider/Payer & Societal: Healthcare perspective (only direct medical costs); Societal perspective (direct medical, direct non-medical and indirect costs)
3 / Eligible Population / Indonesia 2011 birth cohort (4,200,000 infants), Source: Wilopo et al 2009. Age-structured cohort model, takes age-specific breastfeeding rates into account; Birth cohort followed for 5 years; No accounting for population change over time because just one year time horizon. No justification provided for source of 2011 birth cohort; estimate comes from a prior economic evaluation but no sources provided.
4 / Current Interventions / No vaccine introduction; Current mix of outpatient care and hospitalisations: includes direct costs (medication, diagnostics, and bed costs; for mild cases, expenditure for ORT), direct non-medical (transportation), and indirect costs (productivity loss due to rotavirus-diarrhea by the caregiver) estimated from hospitalization data and outpatient visit costs from previous Indonesian microcosting study.
5 / Uptake of New Interventions / Rotateq (3-dose): coverage at 94% based on 2011 DPT coverage, assuming administration at same time; no scale up explained
6 / Costs of Introducing New Vaccine / Procurement cost=US$5/dose (market) and US$0.3/dose (GAVI-subsidized); Other operational costs not microcosted
7 / Impact on Health Care Systems Costs / Yes, models impact of vaccine on disease burden and health care costs: Used vaccine efficacy rates specific to rotavirus-associated hospitalizations and prevention of outpatient visitsdeaths (based on previous economic evaluation). Considered lowered efficacy for lower doses and assumed reductions in vaccine efficacy over time. Takes breastfeeding into account, but does not consider vaccine serotypes, serotype replacement, or herd immunity.
8 / Programmatic Time Horizon / 1 year (2011); Not justified
9 / Discounting and Time Dependencies / Discounting: 3%; Time dependencies: All cost items available in 2007 prices were converted to 2011US$ costs (using the underlying growth rate in consumer prices)
10 / Model Type / Age-structured cohort model (based on a decision tree model), developed by the University of Groningen: “Consensus Model on Rotavirus Vaccination” (CoRoVa); Figure of model provided, described in detail
11 / Data Sources / (4+/6) Demography: under five population from the Indonesian Demographic and Health Survey (IDHS) 2007 on age patterns of breastfeeding;Vaccine coverage: 94% (based on DPT vaccine coverage data from WHO and UNICEF); Costs - vaccine price: market and GAVI-subsidised price that applies to country/ administration at US$ 0.5 (based on 2009 Indonesian study); Costs - outpatient and inpatient visits: from a cost study previously conducted in Indonesia (2007, but adjusted to reflect 2011 values)
12 / Cost Estimates/ Budget Impact / Budget impact (costs, not resource use) presented for each 1-year budget period over the 5-year time horizon. Unclear whether this represents 1st year or 'hypothetical steady state' year. Yearly cost of rotavirus vaccination program under market and GAVI-subsidized price are US$ 64.9 million and US$ 10.2 million, respectively; overall immunization budget ($198 million).
13 / Validity / Partial External/Internal Validity: Total costs are compared to country's health budget for immunization (US$ 198 million); inclusion of rotavirus immunization in NIP would be 1/3 of budget if the fully financed by Indonesian government (no GAVI support).
14 / Uncertainty and Scenario Analyses / Traditional Sensitivity Analyses: univariate sensitivity and probabilistic sensitivity analyses carried out; Scenario or "What-if" Analyses: Three scenarios: (i) 100% exclusive breastfeeding, (ii) 100% partial breastfeeding and (iii) 100% no breastfeeding.
15 / Conclusions and Limitations / Conclusions: Affordability analysis indicated a significant difference in required funds for rotavirus vaccination in Indonesia under the GAVI-subsidized vs. market situations; Limitations: application of static model (doesn't capture herd immunity effects); lack of specific rotavirus- related diarrhea incidence data in Indonesia; treatment costs only available for 2007;adjusted to reflect 2011 values
Suwantika 2013b
1 / Setting / (4/5) Financing: Indonesia is faced with limited resources especially on providing required budget both for implementation of rotavirus vaccination and breastfeeding promotion interventions. Getting funds from international organizations could be realistic solution to overcome this problem.Budget: Compared to the total Indonesian government health budget for the whole immunization program in 2011 (US$ 198 million); Decision: Specifies vaccine has not been introduced; Disease: Rotavirus infection reported to be responsible for the majority of severe diarrhea in children under-5-years-old in Indonesia; Health care system: N/A
2 / Study Perspective / Health Care Provider/Payer & Societal
3 / Eligible Population / Indonesia 2011 birth cohort (4,200,000 infants); Source: Wilopo et al. 2009. Age-structured cohort model, takes age-specific breastfeeding rates into account; 5-year-time horizon; Birth cohort followed for 5 years; No accounting for population change over time because just one year time horizon. No justification provided for source of 2011 birth cohort; estimate comes from a prior economic evaluation but no sources provided.
4 / Current Interventions / No vaccine introduction; Current mix of outpatient care and hospitalisations: Health care costs provided for mild, moderate, severe cases estimated from previous Indonesian microcosting study (include cost of stay, diagnostics, medicines, broken down according to who paid)
5 / Uptake of New Interventions / Breastfeeding interventions and/or Rotateq (3-dose): coverage at 94% based on 2011 DPT coverage, assuming administration at same time; no scale up explained
6 / Costs of Introducing New Vaccine / Procurement cost=US$5/dose (market), total price $15.50 including 3-doses and administration costs; Other operational costs not microcosted
7 / Impact on Health Care Systems Costs / Yes, models impact of vaccine on disease burden and health care costs: Assumes impact of interventions looking at vaccine and breastfeeding separately and together (based on previous studies and specific to severity level of disease). Considered lowered efficacy for lower doses and assumed reductions in vaccine efficacy over time, but does not consider vaccine serotypes, serotype replacement, or herd immunity.
8 / Programmatic Time Horizon / 1 year (2011); Not justified
9 / Discounting and Time Dependencies / Discounting: 3%; Time dependencies: converted to 2011US$ costs (using annual inflation rates)
10 / Model Type / Cost-effectiveness model, developed by the University of Groningen: “Consensus Model on Rotavirus Vaccination” (CoRoVa);Links to model provided
11 / Data Sources / (3+/6) Demography: under five population from the Indonesian Demographic and Health Survey (IDHS) 2007 on age patterns of breastfeeding; Burden of disease: estimated 2011 diarrhea cases over breastfeeding statuses by applying 2007 data and relative risk of diarrhea morbidity by feeding statuses (WHO);Costs - outpatient and inpatient visits: from a cost study previously conducted in Indonesia (2007, but adjusted to reflect 2011 values)
12 / Cost Estimates/ Budget Impact / Budget impact (costs, not resource use) presented for each 1-year budget period over the 5-year time horizon. Unclear whether this represents 1st year or 'hypothetical steady state' year. Yearly cost of rotavirus vaccination program under market price (US$ 63.9-64.1 million) not realistic within overall immunization budget ($198 million).
13 / Validity / Partial External/Internal Validity: Total costs are compared to country's health budget for immunization (US$ 198 million); inclusion of rotavirus immunization in NIP would be 1/3 of budget if the fully financed by Indonesian government (no GAVI support).
14 / Uncertainty and Scenario Analyses / Traditional Sensitivity Analyses: univariate sensitivity and probabilistic analyses, took uncertainties into account; Scenario or "What-if" Analyses: Three scenarios: (i) breastfeeding education intervention, (ii) breastfeeding support intervention, (iii) combined effect of education and support interventions.
15 / Conclusions and Limitations / Conclusions: required fund by the government for universal rotavirus vaccination unrealistic when compared to total Indonesian government health budget for the whole immunization program in 2011 (US$ 198 million); Limitations: no herd immunity; lack of 2011 data on rotavirus- diarrhea incidence in Indonesia
Muangchana 2012
1 / Setting / (5/5) Financing: Can assume entirely self funded; Budget: Currently, approximately US$23.3 million is spent annually for purchasing vaccines for 10 diseases (US$2.3 million per disease); Decision: Specifies vaccine has not been introduced into EPI, although voluntary immunization available; Disease: country-specific prevalence of top rotavirus serotypes presented; Health care system: new logistics method was outsourced to the Government Pharmaceutical Office (a state enterprise)prices of vaccines have a major effect on logistics cost
2 / Study Perspective / Health Care Provider/Payer & Societal
3 / Eligible Population / Thailand 2009 birth cohort (733,014 children), Source: Department of Disease Control;Birth cohort followed for 5 years; No accounting for population change over time because just one year time horizon. Appropriate source for population numbers.
4 / Current Interventions / No vaccine introduced within routine immunization schedule, but 2- and 3-dose vaccine available for voluntary immunization. Approximately 27,000 children are vaccinated per year, while new births are more than 700,000 children per year; Current mix of outpatient care and hospitalisations: Cost of illness covered: direct medical cost, including cost before and after hospital treatment; From 2 local costing studies for rotavirus (one of which states: employing a micro-costing approach)
5 / Uptake of New Interventions / Voluntary immunization available (2-dose, 3-dose): coverage estimated at 98.6% based on OPV immunization from EPI survey, assuming administration at same time; no scale up explained