Impact and cost-effectiveness of national implementation of rotavirus vaccination in Vietnam: A modeling study

Background In Vietnam, rotavirus remains a leading cause of severe acute gastroenteritis resulting in hospitalization. Although rotavirus vaccines are available in the private sector—primarily accessible to urban children—the Expanded Programme on Immunization has only piloted the vaccine in select provinces. This study assessed the impact and cost-effectiveness of national rotavirus vaccination in Vietnam to inform policy decision on nationwide implementation. Methods We used a transparent static cohort model with a granular weekly age structure (< 5 years) to project rotavirus gastroenteritis (RVGE) cases, visits, hospitalizations, and deaths in children under five years, comparing no vaccination to nationwide vaccination with the domestic ROTAVIN vaccine over 10 years starting in 2026. Model inputs drew from global, regional, and local data including pre-vaccine incidence in Vietnam, local vaccine effectiveness and waning data, and treatment costs (governmental and societal perspectives) sourced from a local cost of illness study and hospital records (converted to 2025 USD). Deterministic and probabilistic sensitivity analyses addressed parameter uncertainty. Results Over ten years, ROTAVIN vaccination was projected to reduce RVGE health burden by 42%, averting 97,776 (95% uncertainty interval 72,722–342,311) hospital admissions and 433 (330−1300) deaths. The program would cost US$39.5 million ($30.7–$117.7 million) for ten birth cohorts (2026–2036). From the governmental perspective, at least 62% of vaccination costs would be offset by healthcare savings. The cost per DALY averted was estimated at $982 (governmental perspective), while the program was cost-saving from the societal perspective in the base case. Sensitivity analyses confirmed robustness, with a 99% probability of cost-effectiveness from the governmental perspective at a willingness-to-pay threshold of 0.5 times Vietnam's GDP per capita (and 100% from the societal perspective). Conclusions Nationwide ROTAVIN vaccination could avert a substantial health and economic burden in Vietnam and would be highly cost-effective given recently published thresholds.