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Modelling the relative cost-effectiveness of the RTS,S/AS01 malaria vaccine compared to investment in vector control
Hillary M Topazian1, Nora Schmit1, Ines Gerard-Ursin1
1MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
Insights
The RTS,S malaria vaccine is cost-effective at under $9.30 per dose in most scenarios. Scaling up insecticide-treated nets (ITNs) and seasonal malaria chemoprevention (SMC) are key priorities.
Area of Science:
- Global Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- The World Health Organization recommends the RTS,S/AS01 (RTS,S) malaria vaccine for children in high-transmission areas.
- Limited vaccine supply necessitates evaluating its cost-effectiveness against existing malaria control interventions.
Purpose of the Study:
- To model the cost-effectiveness of the RTS,S vaccine in diverse sub-Saharan African settings.
- To compare RTS,S implementation with scaling up insecticide-treated nets (ITNs), next-generation ITNs, and seasonal malaria chemoprevention (SMC).
Main Methods:
- An individual-based mathematical model simulating Plasmodium falciparum transmission was used.
- Cost-effectiveness was analyzed across various rainfall patterns, ITN coverage, treatment rates, and parasite prevalence.
- RTS,S administration strategies were compared against enhanced ITN use and SMC introduction.
Main Results:
- RTS,S was cost-effective (≤$9.30/dose) in over 90% of modeled scenarios.
- High ITN coverage (≥60%) and/or SMC presence reduced the cost-effectiveness threshold for RTS,S.
- Layering RTS,S onto existing interventions significantly reduced malaria cases.
Conclusions:
- RTS,S effectively reduces malaria cases and deaths, even alongside other interventions.
- Prioritizing scale-up of ITNs, SMC, and next-generation nets is crucial in eligible settings for cost-effectiveness.
Background:
The World Health Organization has recommended a 4-dose schedule of the RTS,S/AS01 (RTS,S) vaccine for children in regions of moderate to high P. falciparum transmission. Faced with limited supply and finite resources, global funders and domestic malaria control programs will need to examine the relative cost-effectiveness of RTS,S and identify target areas for vaccine implementation relative to scale-up of existing interventions.
Methods:
Using an individual-based mathematical model of P. falciparum, we modelled the cost-effectiveness of RTS,S across a range of settings in sub-Saharan Africa, incorporating various rainfall patterns, insecticide-treated net (ITN) use, treatment coverage, and parasite prevalence bands. We compare age-based and seasonal RTS,S administration to increasing ITN usage, switching to next generation ITNs in settings experiencing insecticide-resistance, and introduction of seasonal malaria chemoprevention (SMC) in areas of seasonal transmission.
Results:
For RTS,S to be the most cost-effective intervention option considered, the maximum cost per dose was less than $9.30 USD in 90.9% of scenarios. Nearly all (89.8%) values at or above $9.30 USD per dose were in settings with 60% established bed net use and / or with established SMC, and 76.3% were in the highest PfPR2-10 band modelled (40%). Addition of RTS,S to strategies involving 60% ITN use, increased ITN usage or a switch to PBO nets, and SMC, if eligible, still led to significant marginal case reductions, with a median of 2,653 (IQR: 1,741 to 3,966) cases averted per 100,000 people annually, and 82,270 (IQR: 54,034 to 123,105) cases averted per 100,000 fully vaccinated children (receiving at least three doses).
Conclusions:
Use of RTS,S results in reductions in malaria cases and deaths even when layered upon existing interventions. When comparing relative cost-effectiveness, scale up of ITNs, introduction of SMC, and switching to new technology nets should be prioritized in eligible settings.
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