The Economic Burden of Rotavirus Diarrhea: Taiwan Perspectives

  • Kow-Tong Chen


Worldwide, rotavirus is the principal cause of diarrheal illness in young children. Rotavirus  infection causes significant morbidity and mortality, often inflicting emotional distress and financial burden on the family and the society.

Disease surveillance has revealed that the incidence of rotavirus infections in infants and young children is similar in both developing and developed countries. Despite so, the burden of mortality is most pronounced in the poorest countries with limited healthcare access, while morbidity is of greater significance in the developed countries. Asia’s diverse populations and economies therefore present a full spectrum of disease burden. The main drivers of rotavirus burden are direct costs (e.g., hospitalizations) and indirect costs (e.g., loss of productivity). Indirect costs are substantial in industrialized counties. The estimated annual social and medical costs due to rotavirus infections in the United States were over US $1 billion and US $264 million, respectively, demonstrating a clear emphasis of indirect over direct cost. In contrast, the estimated annual social and hospital costs for rotavirus-associated admission in Taiwan were US $13.3 million and US $10.4 million, respectively, showing the equivalence in direct and indirect cost burden.

Although few countries have evaluated its economic impact or considered the potential  cost effectiveness (CE) of rotavirus  universal mass vaccination (UMV), the magnitude of rotavirus disease burden is recognized. Rotavirus vaccine could markedly alleviate the ensuing disease toll on both society and the economy but to maximize its benefits, it will be important to increase its coverage.


Indirect Cost National Health Insurance Program Taiwan National Health Insurance Total Indirect Cost Sentinel Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


 acute gastroenteritis


 Asian Rotavirus Surveillance Network


Bureau of National Health Insurance


cost effectiveness




 global alliance for vaccine and immunization

ICD-9 CM codes

International Classification of Disease, ninth edition, Clinical Modification Code (ICD-9 CM Code)


 length of stay


out-patient department


 oral rehydration therapy


reverse transcription-polymerase chain reaction


 sentinel hospital


universal mass vaccination


World Health Organization


  1. Ball JM, Tian P, Zeng CQ-Y, Morris AP, Estes MK. (1996). Science. 272: 101–104.PubMedCrossRefGoogle Scholar
  2. Berner R, Schumacher RF, Hameister S, Forster J. (1999). Acta Paediatr Suppl. 426: 48–52.CrossRefGoogle Scholar
  3. Berstein DI, Glass RI, Rodgers G, Davidson BL, Sack DA. (1995). JAMA. 73: 1191–1196.CrossRefGoogle Scholar
  4. Bloom BS, Bruno DJ, Maman DY, Jayadevappa R. (2001). Pharmacoeconomics. 19: (2)207–213.PubMedCrossRefGoogle Scholar
  5. Blutt SE, Kirkwood CD, Parreno V, Warfield KL, Cicarlet M, Estes MK, Bok K, Bishop RE, Conner ME. (2003). Lancet. 362: 1445–1449.PubMedCrossRefGoogle Scholar
  6. Bresee J, Fang ZY, Wang B, Nelson EA, Tam J, Soenarto Y,Wilopo SA, Kilgore P, Kim JS, Kang JO, Lan WS,Gaik CC, Moe K, Chen KT, Jiraphongsa C,Ponguswanna Y, Nguyen VM, Phan VM, Le TL,Hummelman E, Gentsch JR, Glass RI. (2004). Emerg Infect Dis. 10: 988–995.PubMedGoogle Scholar
  7. Bureau of National Health Insurance. (2006). The National Health Insurance Annual Statistical Report, 2004. Accessed on 15 August 2006 by
  8. Caul EO. (1994). Lancet. 343: 1240–1242.PubMedCrossRefGoogle Scholar
  9. Chan PK, Tam JS, Nelson EA, Fung KS, Adeyemi-Doro FA, Fok TF, Cheng AF. (1998). Epidemiol Infect. 120: 321–325.PubMedCrossRefGoogle Scholar
  10. Chen KT, Chen PY, Tang RB, Huang YF, Lee PI, Yang JY, Chen HY, Bresee J, Hummelmen E, Roger RI. (2005). J Infect Dis. 92: s44–s48.CrossRefGoogle Scholar
  11. Chen KT, Fan SF, Tang RB, Huang YF, Lee PI, Chen PY, Tang CW, Chen HC. (2007). Vaccine. 25: 4266–4272.PubMedCrossRefGoogle Scholar
  12. Clark HF, Offit PA, Ellis RW, Krah D, Shaw AR, Eiden JJ, Pichichero M, Treanor JJ. (1996). Arch Virol. 12: (Suppl)187–198.Google Scholar
  13. Clements-Mann ML, Makhene MK, Mrukowicz J, Wright PF, Hoshino Y, Midthun K, Sperber E, Karron R, Kapikian AZ. (1999). Vaccine. 17: 2715–2725.PubMedCrossRefGoogle Scholar
  14. Cone R, Mohan K, Thouless M, Corey L. (1988). Pediatr Infect Dis. J. 7: 103–109.PubMedCrossRefGoogle Scholar
  15. Cook SM, Glass RI, LeBaron CW, Ho MS. (1990). Bull World Health Organ. 68: 171–177.PubMedGoogle Scholar
  16. David LH. (2004). In: David LH (ed.) Control of Communicable Disease Manual. American Public Health Association, Washington, DC, pp. 224–227.Google Scholar
  17. de Zoysa I, Feachem RG. (1985). Bull World Health Organ. 63: 569–583.PubMedGoogle Scholar
  18. Ehreth J. (2003). Vaccine. 21: 4105–4117.PubMedCrossRefGoogle Scholar
  19. Ernst RL, Hay JW. (1994). Am J Public Health. 84: 1261–1264.PubMedCrossRefGoogle Scholar
  20. Estes MK. (2001). In: Knipe DM, Howley PM (eds) Fields Virology, 4th ed. Lippincott-Raven, Philadelphia, PA, pp. 1747–1786.Google Scholar
  21. Estes MK, Graham DY, Smith EM, Gerba CP. (1979). J Gen Virol. 43: 403–409.PubMedCrossRefGoogle Scholar
  22. Flewett TH, Woode GN. (1978). Arch Virol. 57: 1–23.PubMedCrossRefGoogle Scholar
  23. Gentsch JR, Laid AR, Bielfelt B, Griffin DD, Banyai k, Ramachandran PM, Jain V, Cunliffe NA, Nakagomi O, Kirkwood CD, Fisher TK, Parashar UD, Bresee JS, Jiang B, Glass GI. (2005). J Infect Dis. 192(Suppl 1):S146–S159.PubMedCrossRefGoogle Scholar
  24. Glass RI, Parashar UD, Bresee JS, et al. (2006). Lancet. 368: 323–332.PubMedCrossRefGoogle Scholar
  25. Greenberg HB, Kalica AR, Wyatt RG, Jones RW, Kapikian AZ, Chanock RM. (1981). Proc Natl Acad Sci USA. 78: 420–424.PubMedCrossRefGoogle Scholar
  26. Grimwood K, Lund JC, Coulson BS, Hudson IL, Bishop RF, Barnes GL. (1988). J Clin Microbiol. 26: 732–738.PubMedGoogle Scholar
  27. Hodgson TA. (1989). Health Policy. 11: 57–60.PubMedCrossRefGoogle Scholar
  28. Jain V, Parashar UD, Glass RI, Bhan MK. (2001). Indian J Pediatr. 68: 855–862.PubMedCrossRefGoogle Scholar
  29. Jiang B, Gentsch JR, Glass RI. (2002). Clin Infect Dis. 34: 1351–1361.PubMedCrossRefGoogle Scholar
  30. Johansen K, Bonnet R, Bondessen K, Eriksson M, Hedlund KO, De Verdier Klingenberg K, Uhnoo I, Svensson L. (1999). Acta Paediatr. 88: 20–23.CrossRefGoogle Scholar
  31. Kapikian AZ, Hoshino Y, Chanock RM (2001). In: Knipe DM, Howley PM (eds.) Fields Virology, 4th ed. Lippincott Williams & Wilkins, Philadelphia, PA, pp. 1787–1834.Google Scholar
  32. Kapikian AZ, Hoshino Y, Chanock RM, Perez-Schael I. (1996). J Infect Dis. 174(Suppl): S65–S72.PubMedCrossRefGoogle Scholar
  33. Kilgore PE, Unicomb LE, Gentsch JR, Albert MJ, McElroy CA, Glass RI. (1996). Pediatr Infect Dis J. 15: 672–677.PubMedCrossRefGoogle Scholar
  34. Koopmanschap MA. (1998). Pharmacoeconomics. 14: 143–148.PubMedCrossRefGoogle Scholar
  35. Kordasti S, Sjovall H, Lundgren O, Svensson L. (2004). Gut. 53: 952–957.PubMedCrossRefGoogle Scholar
  36. Kosek M, Bern C, Guerrant RL. (2003). Bull World Health Organ. 81: 197–204.PubMedGoogle Scholar
  37. Lu CY, Lauderdale TL, Fang YU, Wang CY, Ho YH, Hung CL, Chang LY, Lee CY, Huang LM. (2006). BMC Infect Dis. 6: 176.PubMedCrossRefGoogle Scholar
  38. Lynch M, Lee B, Azimi P, Gentsch J, Glaser L, Gilliam S, Chang HG, Ward R, Glass RI. (2001). Clin Infect Dis. 33: 932–938.PubMedCrossRefGoogle Scholar
  39. Lynch M, Shieh WJ, Tatti K, Gentsch JR, Ferebee-Harris T, Jiang B, Guarner J, Bresee JS, Greenwald M, Cullen S, Davies HD, Trevenen C, Zaki SR, Glass RI. (2003). Clin Infect Dis. 37: 1327–1333.PubMedCrossRefGoogle Scholar
  40. Nakagomi T, Nakagomi O, Takahashi Y, Enoki M, Suzuki T, Kilgore PE. (2005). J Infect Dis. 192: S106–S110.PubMedCrossRefGoogle Scholar
  41. Nelson EA, Tam JS, Yu LM, Ng YC, Bresee JS, Poon KH, Ng CH, IP KS, Mast TC, Chan PK, Parashar UD, Fok TF, Glass RI. (2005). J Infect Dis. 192: s64–s70.PubMedCrossRefGoogle Scholar
  42. Pang XL, Joensuu J, Vesikari T. (1996). Pediatr Infect Dis J. 15: 543–545.PubMedCrossRefGoogle Scholar
  43. Parashar UD, Gibson CJ, Bresee JS, Glass RI. (2006). Emerg Infect Dis. 12: 304–306.PubMedGoogle Scholar
  44. Podewils LJ, Antil L, Hummelman E, Bresee J, Parashar UD, Rheingans R. (2005). J Infect Dis. 192: s133–s145.PubMedCrossRefGoogle Scholar
  45. Rice DP. (1994). Lancet. 344: 1519–1520.PubMedCrossRefGoogle Scholar
  46. Rice DP, Kelman S, Miller LS. (1992). Hosp Community Psychiatry. 43: 1227–1232.PubMedGoogle Scholar
  47. Richardson S, Grimwood K, Gorrell R, Palombo E, Barnes G, Bishop R. (1998). Lancet. 351: 1844–1848.PubMedCrossRefGoogle Scholar
  48. Rodrigues A, de Carvalho M, Monteiro S, Mikkelsen CS, Aaby P, Mølbak K, Fischer TK. (2007). Pediatr Infect Dis J. 26: 233–237.PubMedCrossRefGoogle Scholar
  49. Sazawal S, Bhatnager S, Bhan MK, Sakena SK, Arora NK, Aggarwal SK, Kashyap DK. (1991). J Pediatr Gasteroenterol Nutr. 12: 461–468.CrossRefGoogle Scholar
  50. Shiell A, Gerard K, Donaldson C. (1987). Health Policy. 8: 317–323.CrossRefGoogle Scholar
  51. Tarricone R. (2006). Health Policy. 77: 51–63.PubMedCrossRefGoogle Scholar
  52. Tucker AW, Haddix AC, Bresee JS, Holman RC, Parashar UD, Glass GI. (1998). JAMA. 279: 1371–1376.PubMedCrossRefGoogle Scholar
  53. Velazquez FR, Calva JJ, Lourdes Guerrero M, Mass D, Glass RI, Pickering LK, Ruiz-Palacios GM. (1993). Pediatr Infect Dis J. 12: 54–61.CrossRefGoogle Scholar
  54. Velazquez FR, Matson DO, Calva JJ, Guerrero L, Morrow L, Carter-Campbell S, Glass RI, Estes MK, Pickering LK, Ruiz-Palacios GM. (1996). N Engl J Med. 335: 1022–1028.PubMedCrossRefGoogle Scholar
  55. Vesikari T, Karvonen A, Prymula R, Schuster V, Tejedor JC, Cohen R, Meurice F, Han HH, Damaso S, Bouckenooghe A. (2007). Lancet. 370: 1757–1763.PubMedCrossRefGoogle Scholar
  56. Vesikari T, Matson DO, Dennehy P, Damme PV, Santosham M, Rodriguez Z, Dallas MJ, Heyse JF, Goveia MG, Black SB, Shinefield HR, Christie CD, Ylitalo S, Itzler RF, Coia ML, Onorato MT, Adeyi BA, Marshall GS, Gothefors L, Campens D, Karvonen A, Watt JP, O’Brien KL, DiNubile MJ, Clark HF, Boslego JW, Offit PA, Heaton PM. (2006). N Engl J Med. 354: 23–33.PubMedCrossRefGoogle Scholar
  57. Weiss KB, Gergen PJ, Hodgson TA. (1992). N Engl J Med. 326: 862–866.PubMedCrossRefGoogle Scholar
  58. Westerman LE, McClure HM, Jiang B, Almond JW, Glass RI. (2005). Proc Natl Acad Sci USA. 102: 7268–7273.PubMedCrossRefGoogle Scholar
  59. World Health Organization. (2000). Report of the Meeting on Future Directions for Rotavirus Vaccine Research in Developing Countries. World Health Organization, Geneva, Switzerland, pp. 1–56.Google Scholar

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  • Kow-Tong Chen

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