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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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Related in: MedlinePlus

Two-way sensitivity analysis of vaccine price and efficacy duration: health services’ perspective. This graph demonstrates the range of vaccine prices and vaccine duration of efficacy where vaccines are more cost-effective than LLINs.
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Figure 2: Two-way sensitivity analysis of vaccine price and efficacy duration: health services’ perspective. This graph demonstrates the range of vaccine prices and vaccine duration of efficacy where vaccines are more cost-effective than LLINs.

Mentions: Two-way sensitivity analyses were carried out on the duration of vaccine efficacy and the vaccine price. As shown in Figures 2 and 3, vaccine price has little impact on which intervention the model finds to be the most cost-effective, however the impact of the duration of vaccine efficacy appears to be significant. This is in line with the threshold analysis results. In other words, the cost-effectiveness of RTS,S vaccines might be greatly determined by their duration of protection, but not by their price.


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)

Two-way sensitivity analysis of vaccine price and efficacy duration: health services’ perspective. This graph demonstrates the range of vaccine prices and vaccine duration of efficacy where vaccines are more cost-effective than LLINs.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Two-way sensitivity analysis of vaccine price and efficacy duration: health services’ perspective. This graph demonstrates the range of vaccine prices and vaccine duration of efficacy where vaccines are more cost-effective than LLINs.
Mentions: Two-way sensitivity analyses were carried out on the duration of vaccine efficacy and the vaccine price. As shown in Figures 2 and 3, vaccine price has little impact on which intervention the model finds to be the most cost-effective, however the impact of the duration of vaccine efficacy appears to be significant. This is in line with the threshold analysis results. In other words, the cost-effectiveness of RTS,S vaccines might be greatly determined by their duration of protection, but not by their price.

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