Cost-benefit analysis of the rubella vaccination in Japan to prevent congenital rubella syndrome: analyses from three perspectives

In Japan, the number of reports of rubella has increased since 2012, with 14,344 cases being reported in 2013. Rubella infection in a first-trimester pregnant woman could result in congenital rubella syndrome (CRS), which causes serious complications. Many municipalities across the country have implemented programs to control the spread, such as offering a subsidy for the vaccination. The aim of this study is to evaluate the vaccination program for a couple planning pregnancy. We defined two different vaccination models-one for couples and one for females only-in order to compare cases of the program. Economic evaluation was conducted by calculating the benefit-cost ratio (BCR) and net present value (NPV), analyzing from three perspectives: of the society, of the payer for healthcare service, and of the healthcare service recipient. For the base case analysis, rubella cases in 5,564 men and 1,727 women and 34 CRS cases were estimated to have been averted. The BCRs of the couples’ program for society was 0.27, and the NPV estimates were approximately -6,111 million yen. The BCRs of the females-only program for society was 0.37. If the price difference between vaccine cost and subsidy is 1,189 yen, there is no effective cost value for the couples’ program from the recipient’s perspective. Incidence, vaccination costs, and subsidy were relatively sensitive parameters. Overall, the female program was preferable to the couples’ program. Correspondence to: Tomoya Itatani, Division of Nursing, Faculty of Health Science Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan; E-mail: [email protected]