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The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study
The Lancet Infectious Diseases ( IF 56.3 ) Pub Date : 2024-02-08 , DOI: 10.1016/s1473-3099(23)00816-2 Nora Schmit , Hillary M Topazian , H Magloire Natama , Duncan Bellamy , Ousmane Traoré , M Athanase Somé , Toussaint Rouamba , Marc Christian Tahita , Massa dit Achille Bonko , Aboubakary Sourabié , Hermann Sorgho , Lisa Stockdale , Samuel Provstgaard-Morys , Jeremy Aboagye , Danielle Woods , Katerina Rapi , Mehreen S Datoo , Fernando Ramos Lopez , Giovanni D Charles , Kelly McCain , Jean-Bosco Ouedraogo , Mainga Hamaluba , Ally Olotu , Alassane Dicko , Halidou Tinto , Adrian V S Hill , Katie J Ewer , Azra C Ghani , Peter Winskill
The Lancet Infectious Diseases ( IF 56.3 ) Pub Date : 2024-02-08 , DOI: 10.1016/s1473-3099(23)00816-2 Nora Schmit , Hillary M Topazian , H Magloire Natama , Duncan Bellamy , Ousmane Traoré , M Athanase Somé , Toussaint Rouamba , Marc Christian Tahita , Massa dit Achille Bonko , Aboubakary Sourabié , Hermann Sorgho , Lisa Stockdale , Samuel Provstgaard-Morys , Jeremy Aboagye , Danielle Woods , Katerina Rapi , Mehreen S Datoo , Fernando Ramos Lopez , Giovanni D Charles , Kelly McCain , Jean-Bosco Ouedraogo , Mainga Hamaluba , Ally Olotu , Alassane Dicko , Halidou Tinto , Adrian V S Hill , Katie J Ewer , Azra C Ghani , Peter Winskill
The R21/Matrix-M vaccine has demonstrated high efficacy against clinical malaria in children in sub-Saharan Africa. Using trial data, we aimed to estimate the public health impact and cost-effectiveness of vaccine introduction across sub-Saharan Africa. We fitted a semi-mechanistic model of the relationship between anti-circumsporozoite protein antibody titres and vaccine efficacy to data from 3 years of follow-up in the phase 2b trial of R21/Matrix-M in Nanoro, Burkina Faso. We validated the model by comparing predicted vaccine efficacy to that observed over 12–18 months in the phase 3 trial. Integrating this framework within a mathematical transmission model, we estimated the cases, malaria deaths, and disability-adjusted life-years (DALYs) averted and cost-effectiveness over a 15-year time horizon across a range of transmission settings in sub-Saharan Africa. Cost-effectiveness was estimated incorporating the cost of vaccine introduction (dose, consumables, and delivery) relative to existing interventions at baseline. We report estimates at a median of 20% parasite prevalence in children aged 2–10 years (PR) and ranges from 3% to 65% PR. Anti-circumsporozoite protein antibody titres were found to satisfy the criteria for a surrogate of protection for vaccine efficacy against clinical malaria. Age-based implementation of a four-dose regimen of R21/Matrix-M vaccine was estimated to avert 181 825 (range 38 815–333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868–405 702) clinical cases per 100 000 fully vaccinated children in seasonal settings. Similar estimates were obtained for seasonal or hybrid implementation. Under an assumed vaccine dose price of US$3, the incremental cost per clinical case averted was $7 (range 4–48) in perennial settings and $6 (3–63) in seasonal settings and the incremental cost per DALY averted was $34 (29–139) in perennial settings and $30 (22–172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PR. Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. The Wellcome Trust, the Bill & Melinda Gates Foundation, the UK Medical Research Council, the European and Developing Countries Clinical Trials Partnership 2 and 3, the NIHR Oxford Biomedical Research Centre, and the Serum Institute of India, Open Philanthropy.
更新日期：2024-02-08
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