Shifting routine rotavirus vaccination to shared clinical decision-making is projected to raise healthcare costs between $34.5 million and $103.5 million, according to a modeling study published Oct. 26 in JAMA Network Open.
The decision analytical model, led by researchers at Washington University School of Medicine in St. Louis, estimated the added clinical and economic burden for a single annual U.S. birth cohort followed through age 2. The figures are in 2025 dollars from a societal perspective.
Researchers modeled three scenarios in which 10%, 20% or 30% of infants shift from fully vaccinated to unvaccinated. Current uptake is 71% fully vaccinated, 15% partially vaccinated and 14% unvaccinated.
Under those scenarios, the model projected an additional 1,500 to 4,500 hospitalizations and 4,400 to 13,200 emergency department visits for acute gastroenteritis by age 2. At baseline, a birth cohort generates more than 20,200 such hospitalizations and 126,800 ED visits. Each acute gastroenteritis hospitalization was estimated to cost $19,675 and each ED visit $1,206, with hospitalizations driving most of the total.
The study follows President Donald Trump’s Aug. 10 executive order to revise the CDC’s childhood vaccine schedule, which includes shifting rotavirus vaccination to shared clinical decision-making, as well as vaccines for hepatitis A, hepatitis B, meningococcal disease, influenza and COVID-19.
The authors said their estimates represent a minimum because the model counts only direct vaccine effects, excluding indirect protection, outpatient visits and publicly insured children.
“Even modest reductions in vaccination uptake may result in increased morbidity and increased clinical and economic burdens,” they wrote, warning that “decades of progress in rotavirus disease prevention are at risk of reversal.”
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