| Nora Schmit, Hillary M. Topazian, H. Magloire Natama, Duncan Bellamy, Ousmane Traoré, M. Athanase Somé, Toussaint Rouamba, Marc Christian Tahita, Massa 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 public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study Journal Article In: The Lancet. Infectious diseases, vol. 24, iss. 5, pp. 465-475, 2024, ISSN: 1474-4457. @article{Schmit2024,
title = {The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study},
author = {Nora Schmit and Hillary M. Topazian and H. Magloire Natama and Duncan Bellamy and Ousmane Traor\'{e} and M. Athanase Som\'{e} and Toussaint Rouamba and Marc Christian Tahita and Massa Achille Bonko and Aboubakary Sourabi\'{e} and Hermann Sorgho and Lisa Stockdale and Samuel Provstgaard-Morys and Jeremy Aboagye and Danielle Woods and Katerina Rapi and Mehreen S. Datoo and Fernando Ramos Lopez and Giovanni D. Charles and Kelly McCain and Jean Bosco Ouedraogo and Mainga Hamaluba and Ally Olotu and Alassane Dicko and Halidou Tinto and Adrian V. S. Hill and Katie J. Ewer and Azra C. Ghani and Peter Winskill},
url = {https://pubmed.ncbi.nlm.nih.gov/38342107/},
doi = {10.1016/S1473-3099(23)00816-2},
issn = {1474-4457},
year = {2024},
date = {2024-01-01},
journal = {The Lancet. Infectious diseases},
volume = {24},
issue = {5},
pages = {465-475},
publisher = {Lancet Infect Dis},
abstract = {Background: The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum 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. Methods: 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\textendash18 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\textendash10 years (PfPR2\textendash10) and ranges from 3% to 65% PfPR2\textendash10. Findings: 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\textendash333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868\textendash405 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\textendash48) in perennial settings and $6 (3\textendash63) in seasonal settings and the incremental cost per DALY averted was $34 (29\textendash139) in perennial settings and $30 (22\textendash172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PfPR2\textendash10. Interpretation: Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. Funding: 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.},
keywords = {Antibodies, Burkina Faso / epidemiology, Child, Cost-Benefit Analysis*, Falciparum* / economics, Falciparum* / epidemiology, Falciparum* / prevention \& control, Female, Hillary M Topazian, Humans, Infant, Malaria, Malaria Vaccines* / administration \& dosage, Malaria Vaccines* / economics, Malaria Vaccines* / immunology, Male, MEDLINE, Models, National Center for Biotechnology Information, National Institutes of Health, National Library of Medicine, NCBI, NIH, NLM, Non-U.S. Gov't, Nora Schmit, Peter Winskill, Plasmodium falciparum / immunology, pmid:38342107, Preschool, Protozoan / blood, Protozoan Proteins / immunology, Public Health* / economics, PubMed Abstract, Research Support, Theoretical*, Vaccine Efficacy},
pubstate = {published},
tppubtype = {article}
}
Background: The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum 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. Methods: 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 (PfPR2–10) and ranges from 3% to 65% PfPR2–10. Findings: 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 PfPR2–10. Interpretation: Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. Funding: 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. |
