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

Seo MK, Baker P, Ngo KN - Malar. J. (2014)

Bottom Line: 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.The 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: MSc in Health Policy, Planning and Financing, London School of Hygiene and Tropical Medicine and London School of Economics, London, UK. seokelly@gmail.com.

ABSTRACT

Background: New 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.

Methods: A 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'.

Results: From 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.

Conclusion: The 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.

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Structure of the model. Every five days, cohort members face the probability of moving to the next health state as depicted by arrows in the diagram.
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Figure 1: Structure of the model. Every five days, cohort members face the probability of moving to the next health state as depicted by arrows in the diagram.

Mentions: The population in the model was a hypothetical Malawian birth cohort. The cohort experienced two epidemiological processes. Firstly, the age-specific non-malaria mortality rate was applied, based on World Health Organization (WHO) life tables [23]. Secondly, malaria morbidity and mortality was modelled using five mutually exclusive health states – well, mild malaria, cerebral malaria (CM), severe malarial anaemia (SMA), and death (Figure 1) [24]. Cycle lengths were set at five days because one cycle approximates the average mild disease episode, and two cycles approximates the average duration of mild malaria and progression to severe malaria (CM or SMA) [24]. Age-specific, annual epidemiological rates of each disease state were therefore transformed into five-day probabilities [25].


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

Seo MK, Baker P, Ngo KN - Malar. J. (2014)

Structure of the model. Every five days, cohort members face the probability of moving to the next health state as depicted by arrows in the diagram.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016032&req=5

Figure 1: Structure of the model. Every five days, cohort members face the probability of moving to the next health state as depicted by arrows in the diagram.
Mentions: The population in the model was a hypothetical Malawian birth cohort. The cohort experienced two epidemiological processes. Firstly, the age-specific non-malaria mortality rate was applied, based on World Health Organization (WHO) life tables [23]. Secondly, malaria morbidity and mortality was modelled using five mutually exclusive health states – well, mild malaria, cerebral malaria (CM), severe malarial anaemia (SMA), and death (Figure 1) [24]. Cycle lengths were set at five days because one cycle approximates the average mild disease episode, and two cycles approximates the average duration of mild malaria and progression to severe malaria (CM or SMA) [24]. Age-specific, annual epidemiological rates of each disease state were therefore transformed into five-day probabilities [25].

Bottom Line: 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.The 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: MSc in Health Policy, Planning and Financing, London School of Hygiene and Tropical Medicine and London School of Economics, London, UK. seokelly@gmail.com.

ABSTRACT

Background: New 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.

Methods: A 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'.

Results: From 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.

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus