Critical Analysis of Economic Evaluation of the Childhood Rotavirus Vaccination in Low and Lower-Middle-Income Countries: A Systematic Review

Objectives: To identify, critically appraise, and summarize the use of different methods and results of economic evaluations to assess the efficiency of rotavirus vaccination programs in low- and lower-middle-income countries.Methods: A systematic literature search was performed in 3 bibliographic databases, including PubMed, ProQuest, Cochrane Library, and Science Direct (Elsevier) journal website, using key search terms. The study selection process was based on predefined inclusion criteria. The search results were presented using the research flow diagram based on guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The quality assessment of the selected studies was carried out using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist.Results: A total of 21 studies were selected for review. All the studies, except 1, reported rotavirus vaccination to be a costeffective intervention and a high-impact strategy to reduce substantial rotavirus disease burden. A decision analysis model was considered appropriate by all studies, although there were variabilities in the analytic horizon used. Lack of countrylevel data was highlighted by most studies. Multiples of gross domestic product of respective countries were used as a threshold to interpret cost-effectiveness.Conclusions: Rotavirus vaccination was found to be cost-efficient in most settings, including complex humanitarian emergencies. The use of thresholds for interpreting incremental cost-effectiveness ratios and lack of local-level disease incidence and cost of illness data remains a point of contention. Lack of reporting probabilistic sensitivity analysis renders limited robustness to study results.