USING COST-EFFECTIVENESS ANALYSIS TO SUPPORT RESEARCH AND DEVELOPMENT PORTFOLIO PRIORITIZATION FOR PRODUCT INNOVATIONS IN MEASLES VACCINATION

Sunday, 23rd of February 2014

[source]Journal of Infectious Diseases[|source]

After 40 years of using the measles vaccine, it is still true today that millions of infants face a significant risk of death from measles, particularly in highly populated, low-income countries. The current measles vaccine technology—a reconstituted, lyophilized, live-attenuated vaccine delivered by subcutaneous injection—has been the standard for the past 4 decades in developing countries and it is relatively inexpensive. However, because of its inherent limitations in thermo-stability, infant age at administration, and requirements for aseptic technique, syringes, and needles for delivery, international experts have made the case for new measles vaccine formulations and delivery devices that aim to accelerate control efforts by simplifying distribution and administration to reduce personnel needs, as well as by improving injection safety and infectious waste disposal.

In this report, the authors (1) identify and assess the most promising new measles vaccination technologies and (2) use prospective cost-effectiveness analysis based on measles transmission mathematical modeling and micro-costing analysis to explore the health and economic impacts of 4 product innovations for measles control to inform investment decisions. Findings and recommendations are accessible at: http://jid.oxfordjournals.org/content/204/suppl_1/S124.long

 

 Abstract

BACKGROUND: Several potential measles vaccine innovations are in development to address the shortcomings of the current vaccine. Funders need to prioritize their scarce research and development resources. This article demonstrates the usefulness of cost-effectiveness analysis to support these decisions.

METHODS: This study had 4 major components: (1) identifying potential innovations, (2) developing transmission models to assess mortality and morbidity impacts, (3) estimating the unit cost impacts, and (4) assessing aggregate cost-effectiveness in United Nations Children’s Fund countries through 2049.

RESULTS: Four promising technologies were evaluated: aerosol delivery, needle-free injection, inhalable dry powder, and early administration DNA vaccine. They are projected to have a small absolute impact in terms of reducing the number of measles cases in most scenarios because of already improving vaccine coverage. Three are projected to reduce unit cost per dose by $0.024 to $0.170 and would improve overall cost-effectiveness. Each will require additional investments to reach the market. Over the next 40 years, the aggregate cost savings could be substantial, ranging from $98.4 million to $689.4 million.

CONCLUSIONS: Cost-effectiveness analysis can help to inform research and development portfolio prioritization decisions. Three new measles vaccination technologies under development hold promise to be cost-saving from a global perspective over the long-term, even after considering additional investment costs.