Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low-income and middle-income countries: mathematical modelling and early-stage economic evaluation

Abstract

BackgroundMicroarray patches (MAPs) are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes (N&S). To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and cost-effectiveness of introducing measles-rubella MAPs (MR-MAPs) in 70 low-income and middle-income countries (LMICs).MethodsWe used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths and disability-adjusted life-years during 2030–2040. Compared with the baseline scenarios with continuing current N&S-based practice, we evaluated the introduction of MR-MAPs under different measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs.ResultsMR-MAP introduction could prevent 27%–37% of measles burden between 2030 and 2040 in 70 LMICs, compared with the N&S-only immunisation strategy. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Measles treatment cost is a key driver of the net cost of introduction. In countries with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduced treatment costs. Compared with country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16%–81% of LMICs, depending on the MR-MAPs procurement prices and vaccine coverage projections.ConclusionsIntroducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach undervaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination.

The Full Value of Vaccine Assessments Concept—Current Opportunities and Recommendations

“…Moreover, while the paper by Hutubessy et al [9] provides a conceptual framework for conducting FVVAs and the recent paper by Trotter et al provides advice on its practical use [10], there is not yet concrete guidance on the optimal FVVA methods to be used, which would standardize the application of these assessments, facilitate fair comparisons, and allow larger themes or common evidence gaps to be identified. Building on the success of these prior applications and the FVVA framework [9,[17][18][19][20][21][22][23][24][25][26][27][28], we propose three recommendations to continue the development and standardization of FVVA methods, in order to maximize the usefulness of future FVVAs for country and global consumers.…”

“…Beyond the publication, there is also indication that maternal immunization is now also a priority for BMGF, who are engaged in supporting the development of further evidence to explore the capacity in low-resource settings for the potential future introduction of RSV and GBS. At the time of writing, the FVVA framework has been applied to a range of different diseases and vaccines, including Group B Streptococcus, tuberculosis, Group A Streptococcus, measles-rubella micro-array patches (MAPs), and Shigella [17][18][19][20][21][22][23][24][25][26][27][28] (Table 1). Many of these vaccines continue to advance in development, with donors such as Gavi and the Vaccine Alliance, discussing potential mechanisms to fund their introduction.…”