Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa

BMJ Global Health
January 2017; volume 2, issue 1
http://gh.bmj.com/content/2/1?current-issue=y

Article
Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa
Peter Winskill, Patrick GT Walker, Jamie T Griffin, Azra C Ghani
January 24, 2017, 2 (1) e000090; DOI: 10.1136/bmjgh-2016-000090
Abstract
Objectives
To evaluate the relative cost-effectiveness of introducing the RTS,S malaria vaccine in sub-Saharan Africa compared with further scale-up of existing interventions.
Design
A mathematical modelling and cost-effectiveness study.
Setting
Sub-Saharan Africa.
Participants
People of all ages.
Interventions
The analysis considers the introduction and scale-up of the RTS,S malaria vaccine and the scale-up of long-lasting insecticide-treated bed nets (LLINs), indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC).
Main outcome measure The number of Plasmodium falciparum cases averted in all age groups over a 10-year period.
Results
Assuming access to treatment remains constant, increasing coverage of LLINs was consistently the most cost-effective intervention across a range of transmission settings and was found to occur early in the cost-effectiveness scale-up pathway. IRS, RTS,S and SMC entered the cost-effective pathway once LLIN coverage had been maximised. If non-linear production functions are included to capture the cost of reaching very high coverage, the resulting pathways become more complex and result in selection of multiple interventions.
Conclusions
RTS,S was consistently implemented later in the cost-effectiveness pathway than the LLINs, IRS and SMC but was still of value as a fourth intervention in many settings to reduce burden to the levels set out in the international goals.