• Sarah M Bartsch, Kelly J O'Shea, Patrick T Wedlock, Marie C Ferguson, Sheryl S Siegmund, and Bruce Y Lee.
• Public Health Informatics, Computational, and Operations Research (PHICOR), Graduate School of Public Health and Health Policy, City University of New York, New York City, New York.
• Am J Prev Med. 2021 Mar 1; 60 (3): 360-368.

IntroductionWith 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.MethodsIn 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).ResultsCompared 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.ConclusionsThis 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.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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