Potential Clinical and Economic Value of Norovirus Vaccination in the Community Setting

Introduction: With norovirus vaccine candidates currently under development, now is the time to identify the vaccine characteristics and implementation thresholds at which vaccination becomes cost effective and cost saving in a community setting.Methods: In 2020, a norovirus transmission, clinical, and economics computational simulation model representing different U.S. population segments was developed to simulate the spread of norovirus and the potential impact of vaccinating children aged <5 years and older adults (aged <= 65 years).Results: Compared with no vaccination, vaccinating preschool-aged children averted 8%-72% of symptomatic norovirus cases in a community, whereas vaccinating older adults averted 2%-29% of symptomatic cases (varying with vaccine efficacy [25%-75%] and vaccination coverage [10%-80%]). Vaccination with a 25% vaccine efficacy was cost effective (incremental cost-effectiveness ratio <=$50,000 per quality-adjusted life year) when vaccination cost <=$445 and cost saving at <=$370 when vaccinating preschool-aged children and <=$42 and <=$30, respectively, when vaccinating older adults. With a 50% vaccine efficacy, vaccination was cost effective when it cost <=$1,190 and cost saving at <=$930 when vaccinating preschool-aged children and <=$110 and <=$64, respectively, when vaccinating older adults. These cost thresholds (cost effective and cost saving, respectively) further increased with a 75% vaccine efficacy to <=$1,600 and <=$1,300 for preschool-aged children and <=$165 and <=$100 for older adults.Conclusions: This study outlines thresholds at which a norovirus vaccine would be cost effective and cost saving in the community when vaccinating children aged <5 years and older adults. Establishing these thresholds can help provide decision makers with targets to consider when developing and implementing a norovirus vaccine. (C) 2020 American Journal of Preventive Medicine. Published by Elsevier Inc.