PATH Brief: Economic Implications of Switching Rotavirus Vaccine Products in Palestine’s Immunization Program


Comparing the overall costs, impact, and cost-effectiveness of both ROTARIX® and ROTAVAC® rotavirus vaccines.


Country-level decision makers can learn from the experience of Palestine switching from ROTARIX® and ROTAVAC® to determine which vaccine offers the greatest impact and cost-effectiveness in their setting.


The Palestinian Ministry of Health (MOH) introduced the rotavirus vaccine ROTARIX® in its routine immunization program in 2016. Two years later, the MOH decided to switch to ROTAVAC®, a rotavirus vaccine made in India. Given the lower price of ROTAVAC, such a move might seem like a clear choice. In reality, the overall cost of vaccination programs is influenced by a variety of vaccine characteristics, such as the packaging volume and number of doses required. When comparing the health and economic value of different vaccine products, assessing multiple criteria beyond just price allows countries to account for the economic implications of all vaccine characteristics.

This switch therefore provided a unique opportunity to compare the overall costs, impact, and cost-effectiveness of both rotavirus vaccines in a public-sector setting. The resulting analysis, conducted by PATH and partners, found that both vaccines have a high probability of being cost-effective compared to no vaccination in Palestine. But when compared to ROTARIX, ROTAVAC was cost-saving.

Key Points:

  • When accounting for averted healthcare-related costs for households, using either vaccine is a cost-saving intervention, highlighting the economic burden rotavirus represents for households and the Palestinian health system.
  • When comparing the two vaccine products, the results found that switching from ROTARIX to ROTAVAC was also cost-saving due to the lower vaccine price and programmatic costs per dose for ROTAVAC, even when accounting for the additional dose per full course that ROTAVAC requires.
  • The vaccine price itself was lower for ROTAVAC, but the choice of vaccine product also has several potential implications for delivery costs due to differences in the number of doses required, packaging, storage conditions, and stability.
  • For supply chain and service delivery costs, the cost per dose was lower for ROTAVAC than ROTARIX, partly due to its smaller volume per dose. Overall, however, the lower cost of procuring ROTAVAC outweighed these delivery cost considerations. The total vaccination program costs therefore favored ROTAVAC over ROTARIX.
  • Compared to no vaccination program, Palestine’s rotavirus vaccination program ICER estimate from the health system perspective was $1,254 per DALY averted with ROTARIX and $353 per DALY averted for ROTAVAC–both within established cost-effectiveness thresholds. Assuming a similar health impact of both vaccines and with lower vaccination program costs for ROTAVAC, switching from ROTARIX to ROTAVAC was a cost-saving alternative for the Palestinian MOH.

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