Estimating the cost-effectiveness and affordability of future malaria ...

Estimating the cost-effectiveness and
affordability of future malaria vaccines
The project
motivation
National policymakers and other stakeholders have indicated the need for good-quality evidence
on the economic efficiency and impact of malaria vaccines. This is why the PATH Malaria Vaccine
Initiative (MVI) is collaborating with the Johns Hopkins University, the Swiss Tropical and Public
Health Institute, and researchers in endemic African countries to generate data to address
questions related to the cost-effectiveness and affordability of malaria vaccines. These data will
help African countries make timely and informed decisions about malaria vaccine introduction
and use, once a vaccine becomes available.
The context
The need to provide cost-effective interventions and to have information to interpret and use
cost-effectiveness has been increasingly promoted through high-profile calls from national
governments, international agencies, and multilateral initiatives, including the World Bank’s 1993
World Development Report and the 2002 World Health Report (World Health Organization, 2002).
A lack of evidence on cost-effectiveness is thought to have contributed to the slow uptake of
some interventions, such as Haemophilus influenzae type b (Hib) and hepatitis B (HBV) vaccines.
Countries routinely use cost-effectiveness evidence for making policy decisions. Low- and middleincome
countries—such as Ghana and Mexico—have used cost-effectiveness data to prioritize
investments among interventions as part of sector-wide decision-making. High-income countries
routinely use economic evaluations to help prioritize health expenditures and to increase
efficiency within the health sector.
The potential
Decision-making related to malaria vaccines may soon enter a complex phase, as countries
consider the prospect of adopting RTS,S, a first-generation vaccine. If the required public health
information, including safety and efficacy data from the Phase 3 program, is deemed satisfactory,
the World Health Organization has indicated that a policy recommendation for the RTS,S malaria
vaccine candidate is possible as early as 2015, paving the way for decisions by African nations
regarding large-scale implementation of the vaccine through their national immunization
programs. Decision-making around malaria vaccine introduction will take into account, among
other things, the malaria control and treatment methods already in use.

To help facilitate the decision-making process, MVI is supporting a number of studies to provide
policymakers with a set of economic estimates, including:
• Estimates of the economic impact of malaria on households and country health systems. This
“costing” of malaria burden includes both direct and indirect out-of-pocket expenses incurred
by families to prevent and treat malaria, the productivity loss due to the disease, and the
socioeconomic distribution of the economic burden. Initial countries in this multi-country
study include Burkina Faso, Ghana, Nigeria, and Uganda. Country selection is based primarily
on disease burden, the endemicity of malaria, and the lack of economic data.
• Estimates of the cost-effectiveness of adding a malaria vaccine to current malaria-control
measures. These estimates will be produced based upon the “cost of illness” data collected,
and in collaboration with the Swiss Tropical and Public Health Institute’s model.
• Estimates of the budget impact of introducing a malaria vaccine into health systems. This
corresponds to the incremental cost of vaccine implementation relative to each country’s
gross national income; such evidence is important for planning as well as for advocacy at
national and global levels.
MVI will continue to support countries as they prepare to decide about malaria vaccine
introduction.
References
The World Bank, International Bank for Reconstruction and Development. World Development
Report 1993: Investing in Health. New York, NY: Oxford University Press, Inc.; 1993.
World Health Organization (WHO). The World Health Report 2002: Reducing Risks, Promoting Healthy
Life. Geneva, CH: WHO; 2002.
THE PATH MALARIA VACCINE INITIATIVE (MVI) is a global program established at PATH through an initial
grant from the Bill & Melinda Gates Foundation. MVI’s mission is to accelerate the development of malaria
vaccines and ensure their availability and accessibility in the developing world. MVI’s vision is a world free
from malaria. For more information, visit www.malariavaccine.org.
PATH is an international nonprofit organization that creates sustainable, culturally relevant solutions,
enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse
public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies
that change the way people think and act. PATH’s work improves global health and well-being. For more
information, visit www.path.org.
February 2012