Cost-effectiveness of infant respiratory syncytial virus preventive interventions in Mali: A modeling study to inform policy and investment decisions

• Type of Material: Article
• Authors: Rachel S Laufer, University of Maryland; Amanda J Driscoll, University of Maryland; Ranju Baral, PATH; Andrea G Buchwald, Colorado School of Public Health; James D Campbell, University of Maryland; Flanon Coulibaly, Ministère de la Santé, Mali; Fatoumata Diallo, Ministère de la Santé, Mali; Moussa Doumbia, Ministère de la Santé, Mali; Alison P Galvani, Yale School of Public Health; Fadima C Haidara, Ministère de la Santé; Karen L Kotloff, University of Maryland School of Medicine; Adama M Keita, Ministère de la Santé, Mali; Kathleen M Neuzil, University of Maryland School of Medicine; Evan Orenstein, Emory University; Lauren Orenstein, Emory University; Clint Pecenka, PATH; Sambo Sow, Ministère de la Santé, Mali; Milagritos D Tapia, University of Maryland School of Medicine; Justin R Ortiz, University of Maryland School of Medicine; Meagan C Fitzpatrick, University of Maryland School of Medicine
• Language: English
• Date: 2021-08-05
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.vaccine.2021.06.086
• Title of Journal or Parent Work: VACCINE
• Volume: 39
• Issue: 35
• Start Page: 5037
• End Page: 5045
• Grant/Funding Information: This work was financially supported by grant 1,088,264 from the Bill and Melinda Gates Foundation. The funding source had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
• Keywords: Global Health; Pediatric; Pneumonia; Vaccine; Life Sciences & Biomedicine; Respiratory Syncytial Virus; Science & Technology; Prevention; EFFECTIVENESS THRESHOLDS; Research & Experimental Medicine; DISEASE; Immunology; Medicine, Research & Experimental; BLIND; MIDDLE-INCOME COUNTRIES
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Importance: Low- and middle-income countries have a high burden of respiratory syncytial virus lower respiratory tract infections. A monoclonal antibody administered monthly is licensed to prevent these infections, but it is cost-prohibitive for most low- and middle-income countries. Long-acting monoclonal antibodies and maternal vaccines against respiratory syncytial virus are under development. Objective: We estimated the likelihood of respiratory syncytial virus preventive interventions (current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine) being cost-effective in Mali. Design: We modeled age-specific and season-specific risks of respiratory syncytial virus lower respiratory tract infections within monthly cohorts of infants from birth to six months. We parameterized with respiratory syncytial virus data from Malian cohort studies, as well as product efficacy from clinical trials. Integrating parameter uncertainty, we simulated health and economic outcomes for status quo without prevention, intra-seasonal monthly administration of licensed monoclonal antibody, pre-seasonal birth dose administration of a long-acting monoclonal antibody, and maternal vaccination. We then calculated the incremental cost-effectiveness ratio of each intervention compared to status quo from the perspectives of the government, donor, and society. Results: At a price of $3 per dose and from the societal perspective, current monoclonal antibody, long-acting monoclonal antibody, and maternal vaccine would have incremental cost-effectiveness ratios of $4280 (95% CI $1892 to $122,434), $1656 (95% CI $734 to $9091), and $8020 (95% CI $3501 to $47,047) per disability-adjusted life-year averted, respectively. Conclusions and Relevance: In Mali, long-acting monoclonal antibody is likely to be cost-effective from both the government and donor perspectives at $3 per dose. Maternal vaccine would need higher efficacy over that measured by a recent trial in order to be considered cost-effective.