Rachel S Laufer1, Amanda J Driscoll2, Ranju Baral3, Andrea G Buchwald4, James D Campbell5, Flanon Coulibaly6, Fatoumata Diallo7, Moussa Doumbia8, Alison P Galvani9, Fadima C Haidara10, Karen L Kotloff11, Adama M Keita12, Kathleen M Neuzil13, Evan W Orenstein14, Lauren A V Orenstein15, Clint Pecenka16, Samba Sow17, Milagritos D Tapia18, Justin R Ortiz19, Meagan C Fitzpatrick20. 1. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: rlaufer@som.umaryland.edu. 2. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: adriscoll@som.umaryland.edu. 3. PATH, 2201 Westlake Avenue, Suite 200, Seattle, Washington 98121, USA. Electronic address: rbaral@path.org. 4. Department of Environmental and Occupational Health, Colorado School of Public Health, 13001 East 17th Place Aurora, Colorado 80045, USA. Electronic address: andrea.buchwald@cuanschutz.edu. 5. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: jcampbel@som.umaryland.edu. 6. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: fcoulibaly917@gmail.com. 7. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: mathusa2005@yahoo.fr. 8. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: moisedoum@yahoo.fr. 9. Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, 135 College St., New Haven, CT 06510, USA. Electronic address: alison.galvani@yale.edu. 10. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: fhaidara@cvd-mali.org. 11. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: kkotloff@som.umaryland.edu. 12. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: admambyta@gmail.com. 13. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: kneuzil@som.umaryland.edu. 14. Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Rd, Atlanta, Georgia 30322, USA. Electronic address: evan.orenstein@emory.edu. 15. Department of Dermatology, Emory University School of Medicine, 1525 Clifton Rd, Atlanta, Georgia 30322, USA. Electronic address: lauren.orenstein@emory.edu. 16. PATH, 2201 Westlake Avenue, Suite 200, Seattle, Washington 98121, USA. Electronic address: cpecenka@path.org. 17. Centre pour le Développement des Vaccins, Ministère de la Santé, BP251 Bamako, Mali. Electronic address: ssow@som.umaryland.edu. 18. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: mtapia@som.umaryland.edu. 19. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: jortiz@som.umaryland.edu. 20. Center for Vaccine Development & Global Health, 685 W. Baltimore St., University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. Electronic address: meagan.fitzpatrick@som.umaryland.edu.
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.
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.
Authors: Erin Sparrow; Ifedayo Adetifa; Nathorn Chaiyakunapruk; Thomas Cherian; Deshayne B Fell; Barney S Graham; Bruce Innis; David C Kaslow; Ruth A Karron; Harish Nair; Kathleen M Neuzil; Samir Saha; Peter G Smith; Padmini Srikantiah; Fred Were; Heather J Zar; Daniel Feikin Journal: Vaccine Date: 2022-02-17 Impact factor: 4.169