研究背景：輪狀病毒是五歲以下兒童腹瀉的主要原因，幾乎每位兒 童在五歲以前都曾感染輪狀病毒。在工業化國家，如台灣，因其醫療照護的普及與進步，雖然輪狀病毒感染死亡的比例不高，但所造成的經濟負擔卻是相當龐大。2006年時已有兩項輪狀病毒疫苗─RotaTeq、Rotarix上市，我國也在2006年底正式引進此兩項疫苗。
研究目的：本研究欲探討台灣地區五歲以下兒童輪狀病毒疫苗計畫的成本效果和疫苗的最適合價格，作為疫苗接種政策的參考依據。
研究方法：使用醫療和社會觀點之決策樹模型，以五歲以下兒童輪 狀病毒感染造成之疾病、經濟負擔以及疫苗效力，評估2006年出生兒童其輪狀病毒疫苗接種計畫之決策。資料來源為健保資料庫2000年抽樣歸人檔與住院費用清單明細檔，計算出五歲以下輪狀病毒之疾病率與疾病成本，以此推估輪狀病毒之疾病與經濟負擔。在基準值分析後，進行敏感度分析，檢驗變數不確定性對模型的影響。
結果：接種RotaTeq或Rotarix輪狀病毒疫苗，可減少約14萬疾病人 數（80%）、10.9萬名門診病患（81%）和2.1萬名重症病患（85%）。從醫療觀點評估，Rotarix疫苗需降至1,686元，RotaTeq降至1,814元；從社會觀點評估，則是分別為2,546和2,703元，否則都無法達到節省成本。以台灣現行疫苗價格進行估算，從醫療觀點來看，執行Rotarix疫苗計劃需額外投入6.5億，執行RotaTeq疫苗則需要投入8.2億，因此每預防一位疾病人數，Rotarix疫苗的ICER值為4,413元，RotaTeq疫苗為5,457元；從社會觀點來看，則分別需投入5.2億和6.8億，因此在社會觀點下，兩項疫苗ICER值分別為3,431元和4,421元。
結論：雖然輪狀病毒疫苗可以顯著降低台灣五歲以下兒童輪狀病毒造成的疾病負擔，但目前疫苗價格並不符合成本效果，除非價格分別降至2,546元（Rotarix）與2,703元（RotaTeq）。不過，輪狀病毒接種計畫仍有助降低輪狀病毒感染的罹病率。

Background：Rotavirus is the most common cause of diarrhea in children, almost every child has become ill due to rotavirus diarrhea before 5. In developed countries, like Taiwan, because of the available and advanced health care system, the risk of death due to rotavirus diarrhea is very low, but it causes huge economic burden. In 2006, two new vaccines, RotaTeq and Rotarix, have been licensed in many countries; which is also been introduced to Taiwan at the end of the year 2006.
Objectives：This study explored the cost-effectiveness of
national rotavirus immunization program and the break-even price of these two vaccines in Taiwan.
Methods：From health care and societal perspectives, a decision tree model was used to assess the rotavirus vaccination program of 2006 birth cohort by the disease burden, economic burden and vaccine efficacy from birth to age 5. The disease rate and cost data was esimated from the National Health Insurance Research database year 2000
data. After the base-value analysis, a sensitivity analysis was performed for all variables to examine the uncertainties of the model.
Result：A routine rotavirus immunization program with either vaccine could prevent at least 14,000(80%) disease episodes, 109,000(81%) outpatient visits, and 21,000(85%) severe cases. From the health care perspective, the break-even price for of Rotarix vaccine was NT$1,686 and RotaTeq was NT$1,814, otherwise could not be cost-saving. From the
societal perspective, the break-even price for these two vaccines was NT$2,546 and NT$2,703, respectively. At the manufacture’s price of vaccine for Taiwan, the total cost of Rotarix and RotaTeq vaccination program was NT$650 million and NT$820 million from health care perspective, therefore the incremental cost-effectiveness ratio (ICER）was NT$4,413 and NT$5,457 per episode averted. From societal perspective, the total cost of each vaccination program was NT$5.2 million and NT$6.8 million, the ICER is NT$3,431 and NT$4,421.
Conclusion：Even though rotavirus vaccination program could significantly reduce the disease burden in Taiwan, but it would unlikely be cost-saving at present unless the price fell to NT$2,546（Rotarix） and NT$2,703（RotaTeq)per course, respectively. Nonetheless, routine rotavirus vaccination program could reduce the morbidity of rotavirus infection.

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