Background: Globally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual
loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause
of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and
Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the
cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).
Methods: We quantified all health system implementation costs, including programme costs, to calculate the cost
effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration
salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data
were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability
Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a
Markov transition model with weekly cycles up to a five-year time horizon.
Results: The average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban
facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective
compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted,
varying from US$ 80–218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at
a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).
Conclusions: The combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when
willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress
towards achievement of the child health Millennium Development Goals.