Economic Impact of Introducing the RTSS Malaria Vaccine:Cost-Effectiveness and Budget Impact Analysis in 41 Countries

摘要

Malaria is a major public health burden in sub-SaharanAfrica. This study estimated the cost-effectiveness and budget impact of addingfour-dose malaria vaccination in infants or children to existing interventionsin 41 endemic countries in sub-Saharan Africa. A staticMarkov cohort model followed a simulated 2017 birth cohort (36.5 millionchildren) for 15 years in 5-day cycles, comparing three strategies: childvaccination (doses at ages 6, 7.5, 9, and 27 months); infant vaccination (dosesat ages 6, 10, and 14 weeks and 21 months); no malaria vaccination. Thebase-case analysis was conducted from the health system perspective with vaccineprice assumed at USD5/dose and annual discounting of 3% for costs anddisability-adjusted life-years (DALYs). Efficacy was based on the Phase IIIRTS,S clinical trial. The model projected that 24.6million children, or 26.2 million infants, would be vaccinated. Compared with novaccination, child (infant) vaccination was projected to avert 16.8 million (16million) cases of malaria and 113,000 (107,000) malaria deaths in the birthcohort over the 15-year period. The incremental cost-effectiveness ratio wasUSD200/DALY averted (USD225/DALY averted) for child (infant) vaccination, whichrepresents 14% (17%) of the gross domestic product (GDP) per capita threshold.The estimated budget impact was overall larger for infant vaccination but mixedsituations occurred across countries. Vaccine price, discount rate, and parasiteprevalence had the largest effect on cost-effectiveness. Child vaccination with RTS,S would be morecost-effective than infant vaccination across countries. Adding RTS,S malariavaccination to existing interventions would be cost-effective assuming one GDPper capita threshold for both child and infant vaccination in all examinedcountries except for 6 countries with lower transmission.