Assessing the Potential Cost-Effectiveness of Microneedle Patches in Childhood Measles Vaccination Programs: The Case for Further Research and Development

Abstract

Objective: Currently available measles vaccines are administered by subcutaneous injections and require reconstitution with a diluent and a cold chain, which is resource intensive and challenging to maintain. To overcome these challenges and potentially increase vaccination coverage, microneedle patches are being developed to deliver the measles vaccine. This study compares the cost-effectiveness of using microneedle patches with traditional vaccine delivery by syringe-and-needle (subcutaneous vaccination) in children's measles vaccination programs.

Methods: We built a simple spreadsheet model to compute the vaccination costs for using microneedle patch and syringe-and-needle technologies. We assumed that microneedle vaccines will be, compared with current vaccines, more heat stable and require less expensive cool chains when used in the field. We used historical data on the incidence of measles among communities with low measles vaccination rates.

Results: The cost of microneedle vaccination was estimated at US$0.95 (range US$0.71-US$1.18) for the first dose, compared with US$1.65 (range US$1.24-US$2.06) for the first dose delivered by subcutaneous vaccination. At 95 % vaccination coverage, microneedle patch vaccination was estimated to cost US$1.66 per measles case averted (range US$1.24-US$2.07) compared with an estimated cost of US$2.64 per case averted (range US$1.98-US$3.30) using subcutaneous vaccination.

Conclusions: Use of microneedle patches may reduce costs; however, the cost-effectiveness of patches would depend on the vaccine recipients' acceptability and vaccine effectiveness of the patches relative to the existing conventional vaccine-delivery method. This study emphasizes the need to continue research and development of this vaccine-delivery method that could boost measles elimination efforts through improved access to vaccines and increased vaccination coverage.

Fig. 1

Impacts on measles incidence with changes in coverage with the first dose of measles-containing vaccine. Measles-containing vaccine effectiveness of 85 % and a vaccine dropout (those vaccinated with the first dose do not return for the second dose) rate of 7.7 %. Vaccine compliance rate (acceptability) was assumed to be 10 % lower for microneedle patches than the conventional technology. MN microneedle, SC subcutaneous

Fig. 2

Costs per case of measles averted by percentage of the population vaccinated at three levels of vaccine effectiveness, using either a microneedle (MN) patch or subcutaneous (SC) injection. Vaccination coverage in the X-axis represents the first dose of measles but the costs per cases of measles averted also include the costs of the second dose. Costs of vaccines were calculated in 2010 US$. Cost estimates did not include potential medical treatment savings as a result of cases averted

Fig. 3

Average cost-effectiveness ratio of microneedle (MN) patches compared with subcutaneous (SC) injection at different levels of compliance rate of MN patches. Average cost-effectiveness ratio = (average cost-effectiveness of SC injection technology)/(average cost-effectiveness of MN patch technology). In cost-effectiveness ratios calculations, effectiveness of vaccines was set at 85 % and the vaccine coverage level was set at 95 % for both vaccination technologies

Fig. 4

Impact on the number of measles cases occurring by percentage of the population vaccinated with measles-containing vaccine (MCV) at three levels of vaccine effectiveness. Vaccination coverage in the X-axis represents the first dose (MCV1) of measles but the number of measles cases in the Y-axis includes both dosages (MCV1 + MCV2). MN microneedle, SC Inj. subcutaneous injection

Fig. 5

Existing incidence of measles and average cost per case averted for immunization. Note: costs are computed under the scenario of 95 % vaccine coverage and 85 % vaccine effectiveness. MN microneedle, SC Inj. subcutaneous injection

Fig. 6

Relative effectiveness of microneedle (MN) patches to subcutaneous injections (SC Inj.) and average costs per case of measles averted. Note: Effectiveness of SC Inj. held constant for cost comparison of MN patches at different levels of efficiency relative to existing syringe-and-needle technology. Cost of illness is not included in the analysis