Cost-effectiveness analysis of vaccinating children in Malawi with RTS,S vaccines in comparison with long-lasting insecticide-treated nets

Abstract

BackgroundNew RTS,S malaria vaccines may soon be licensed, yet its cost-effectiveness is unknown. Before the widespread introduction of RTS,S vaccines, cost-effectiveness studies are needed to help inform governments in resource-poor settings about how best to prioritize between the new vaccine and existing malaria interventions.MethodsA Markov model simulated malaria progression in a hypothetical Malawian birth cohort. Parameters were based on published data. Three strategies were compared: no intervention, vaccination at one year, and long-lasting, insecticide-treated nets (LLINs) at birth. Both health service and societal perspectives were explored. Health outcomes were measured in disability-adjusted life years (DALYs) averted and costed in 2012 US$. Incremental cost-effectiveness ratios (ICERs) were calculated and extensive sensitivity analyses were conducted. Three times GDP per capita ($1,095) per DALY averted was used for a cost-effectiveness threshold, whilst one times GDP ($365) was considered ‘very cost-effective’.ResultsFrom a societal perspective the vaccine strategy was dominant. It averted 0.11 more DALYs than LLINs and 0.372 more DALYs than the no intervention strategy per person, while costing $10.04 less than LLINs and $59.74 less than no intervention. From a health service perspective the vaccine’s ICER was $145.03 per DALY averted, and thus can be considered very cost-effective. The results were robust to changes in all variables except the vaccine and LLINs’ duration of efficacy. Vaccines remained cost-effective even at the lowest assumed efficacy levels of 49.6% (mild malaria) and 14.2% (severe malaria), and the highest price of $15. However, from a societal perspective, if the vaccine duration efficacy was set below 2.69 years or the LLIN duration of efficacy was greater than 4.24 years then LLINs became the more cost-effective strategy.ConclusionThe results showed that vaccinating Malawian children with RTS,S vaccines was very cost-effective from both a societal and a health service perspective. This result was robust to changes in most variables, including vaccine price and vaccine efficacy, but was sensitive to the duration of efficacy of the vaccine and LLINs. Given the best evidence currently available, vaccines can be considered as a very cost-effective component of Malawi’s future malaria control programmes. However, long-term follow-up studies on both interventions are needed.

Assessment of Burden of Malaria in Gwanda District, Zimbabwe, Using the Disability Adjusted Life Years

“…This study provides data on malaria burden that can be used by policy makers in conducting targeted interventions to reduce the effects of the disease on rural poor communities. DALYs are useful in cost-effectiveness analysis of intervention programmes [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. The results from the study can be used as baseline data for cost-effectiveness analysis of malaria intervention programmes in the district.…”

Management strategies in a malaria model combining human and transmission-blocking vaccines

“…In [25], vaccination cost was estimated at $7 per dose and distribution cost was estimated at $0.35 per dose; using this estimation, we set B 1 = 7.3. We assume that B 1 ≥ B 2 > B 3 , which is based on the assumption that the cost of implementing the mixed TBV & HV vaccination program is more expensive than the cost of implementing the HV vaccination program alone; and implementing vector control program is cheaper than vaccination program.…”

Multi-year optimization of malaria intervention: a mathematical model

“…Vaccine: Cost data for the RTS,S vaccine is not yet available since the vaccine is not yet on the market. Seo et al use an estimate of 7 USD per dose for the vaccine after looking at recent introductory vaccine prices ranging from 1 to 15 USD [31]. They also propose using 0.37 USD administration cost per vaccination based on the price for other vaccines used in Malawi in the Expanded Program on Immunization (EPI).…”

“…They also propose using 0.37 USD administration cost per vaccination based on the price for other vaccines used in Malawi in the Expanded Program on Immunization (EPI). Because the RTS,S vaccine is administered in three doses, they estimate the total cost of the vaccine at 22.11 USD per person per year [31]. Adjusting their 2012 costs to 2009 values for consistency, we arrive at a cost of 20.66 USD per treated person per year [32].…”

“…The total person-days of malaria infection in this scenario is 2.977 billion. Baseline cost for using interventions, per treated person for one year, in 2009 USD[29,30,31].…”