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. 2020 May 22;38(25):4079-4087.
doi: 10.1016/j.vaccine.2020.04.031. Epub 2020 Apr 30.

Case reduction and cost-effectiveness of the RTS,S/AS01 malaria vaccine alongside bed nets in Lilongwe, Malawi

Griffin J Bell  1 , Matthew Loop  2 , Hillary M Topazian  3 , Michael Hudgens  4 , Tisungane Mvalo  5 , Jonathan J Juliano  6 , Portia Kamthunzi  7 , Gerald Tegha  8 , Innocent Mofolo  9 , Irving Hoffman  10 , Jeffrey A Bailey  11 , Michael Emch  12
Affiliations

Case reduction and cost-effectiveness of the RTS,S/AS01 malaria vaccine alongside bed nets in Lilongwe, Malawi

Griffin J Bell et al. Vaccine. .

Abstract

Background: RTS,S/AS01, the most advanced vaccine against malaria, is now undergoing pilot implementation in Malawi, Ghana, and Kenya where an estimated 360,000 children will be vaccinated each year. In this study we evaluate RTS,S/AS01 alongside bed net use and estimate cost-effectiveness.

Methods: RTS,S/AS01 phase III trial and bed net prevalence data were used to determine the effect of vaccination in the urban/periurban and rural areas of Lilongwe, Malawi. Cost data were used to calculate the cost-effectiveness of various interventions over three years.

Findings: Since bed nets reduce malaria incidence and homogeneous vaccine efficacy was assumed, participants without bed nets received greater relative benefit from vaccination with RTS,S/AS01 than participants with bed nets. Similarly, since malaria incidence in rural Lilongwe is higher than in urban Lilongwe, the impact and cost-effectiveness of vaccine interventions is increased in rural areas. In rural Lilongwe, we estimated that vaccinating one child without a bed net would prevent 2·59 (1·62 to 3·38) cases of malaria over three years, corresponding to a cost of $10·08 (7·71 to 16·13) per case averted. Alternatively, vaccinating one child with a bed net would prevent 1·59 (0·87 to 2·57) cases, corresponding to $16·43 (10·16 to 30·06) per case averted. Providing RTS,S/AS01 to 30,000 children in rural Lilongwe was estimated to cost $782,400 and to prevent 58,611 (35,778 to 82,932) cases of malaria over a three-year period. Joint interventions providing both vaccination and bed nets (to those without them) were estimated to prevent additional cases of malaria and to be similarly cost-effective, compared to vaccine-only interventions.

Interpretation: To maximize malaria prevention, vaccination and bed net distribution programs could be integrated.

Funding: Impacts of Environment, Host Genetics and Antigen Diversity on Malaria Vaccine Efficacy (1R01AI137410-01).

Keywords: Africa; Bed nets; Cost-effectiveness; Malaria; Malawi; Vaccine.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1:
Figure 1:
Potential Exposure Combinations in Each Time Interval of Follow-up During the First and Second 18 Months of the Phase III Trial of RTS,S
Figure 2:
Figure 2:
Violin Plots of Follow-up Time by Treatment Group
Figure 3:
Figure 3:. Cases per Year (Transmission Intensity) in the No Bed Net, No Vaccine (NBNV) Group at Baseline versus Cases Averted and Cost per Case Averted.
The dotted vertical line represents the assumed rural incidence of 2 cases per year
Figure 4:
Figure 4:. Cases per Years (Transmission Intensity) in the No Bed Net, No Vaccine (NBNV) Group at Baseline versus Total Cases Averted and Cost per Case Averted in Each Three-Year Rural Intervention
The dotted vertical line represents the assumed rural incidence of 2 cases per year in the control group
See this image and copyright information in PMC

References

    1. World Malaria Report 2018. S.l.: World Health Organization; 2019.
    1. First malaria vaccine in Africa: A potential new tool for child health and improved malaria control. World Health Organization; p. 4.
    1. Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. The Lancet. 2015. July 4;386(9988):31–45. - PMC - PubMed
    1. Moorthy VS, Hutubessy R, Newman RD, Hombach J. Decision-making on malaria vaccine introduction: the role of cost-effectiveness analyses. Bull World Health Organ. 2012. November 1;90(11):864–6. - PMC - PubMed
    1. National Malaria Control Programme - NMCP/Malawi and ICF. 2018. Malawi Malaria Indicator Survey 2017. Lilongwe, Malawi: NMCP/Malawi and ICF; Available at http://dhsprogram.com/pubs/pdf/MIS28/MIS28.pdf.

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