Health and economic burdens of norovirus disease and cost-effectiveness analysis of norovirus vaccination among school age children in the United States
Background. Norovirus disease is of great public health significance as evidenced by the health and economic burdens each year in the United States. Although norovirus disease afflicts all ages in the general population, vulnerable segments of the population include the young and elderly. Currently there is no norovirus vaccine on the market to prevent norovirus infection nor is there prescribed medical treatment other than supportive care for self-limiting symptoms. Methods. Surveillance data on norovirus outbreaks obtained from the Centers for Disease Control National Outbreak Reporting System, school enrollment data obtained from the National Department of Education, healthcare resource utilization data obtained from the Healthcare Cost and Utilization Project, and results from published research findings were used to estimate the health and economic burdens of norovirus disease among the school age population. Decision analysis was used to model the costs and benefits of norovirus vaccination. Cost effectiveness analysis was conducted from the societal and healthcare perspectives in order to determine the incremental cost-effectiveness ratios for the alternative health strategy compared to the current standard health strategy. Univariate and multivariate analyses were conducted in order to examine uncertainty associated with parameters and assess how the uncertainty affects the outputs of the decision model. Probabilistic sensitivity analysis was conducted in order to assess and quantify the impact of varying all parameters at the same time. Results. Norovirus results in high numbers of illnesses and high direct medical, direct non-medical and indirect costs among school age children. In terms of health burden, there were a greater number of cases requiring supportive care than any other health outcome. The cost of supportive care is relatively inexpensive until indirect costs are factored in to the total cost of one episode of norovirus illness. The results of the present study indicated that when comparing the standard health strategy of no norovirus vaccination to that of the alternative health strategy of norovirus vaccination, vaccination was found to be optimal. The results of probabilistic sensitivity analysis indicated that the alternative health strategy was marginally cost effective. Conclusion. The results of the present study represent the first attempt to estimate the health and economic burdens of norovirus disease among the school age population with a focus on norovirus disease spread occurring in closed (schools) environments. The study findings will illustrate the uniqueness of closed environments in perpetuating norovirus spread and the feasibility of norovirus vaccination among school age children. The results of cost-effectiveness analysis indicated vaccination was an optimal strategy but is marginally effective. Given the numerous limitations of using passive surveillance data, future research efforts should use higher quality and more accurate sources of data in order to estimate the health and economic burdens of norovirus disease and examine the other hidden costs of norovirus outbreaks such as environmental decontamination, school closure, student and staff absenteeism and other intangible costs. In addition, future research efforts should use the findings from this and other studies that have identified high prevalence of norovirus disease among younger age groups in order to establish priority age groups for vaccination when a vaccine becomes available on the market. Clinical trials are underway and development of a norovirus vaccine is expected within the next few years.
Venuto, Margaret M, "Health and economic burdens of norovirus disease and cost-effectiveness analysis of norovirus vaccination among school age children in the United States" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10126215.