Portnoy A, Jit M, Ferrari M, Hanson M, Brenzel L, Verguet S. Estimates of case-fatality ratios of measles in low-income and middle-income countries: a systematic review and modelling analysis. Lancet Glob Health. 2019 Feb 20.
While measles mortality has reduced globally, the accurate assessment of measles mortality burden is highly dependent on measures of measles case fatality ratios (CFRs), which vary according to geography, health systems infrastructure, prevalence of underlying risk factors, and measles endemicity. With imprecise measles CFRs, there is continued uncertainty about the current burden of measles mortality and the impact of measles vaccination including its cost-effectiveness and return on investment. By examining mortality outputs, such as CFRs, this analysis examines how future economic evaluations might be impacted, as current health and economic impact models rely heavily on CFR estimations.
In this paper, we build upon the previous review (Wolfson and colleagues, 2009) by: (1) re-examining literature published in 1980-2008; (2) extending its scope to add articles published in 2008-2016; and (3) including hospital-based studies in our analysis. We first conducted a literature review of measles CFRs for both community-based and hospital-based measles cases from empirical data in the published literature from 1980–2016 in low- and middle-income countries. We subsequently developed a prediction model to estimate measles CFRs across heterogeneous groupings (by country; income level; year; age) from 1990–2015. Finally, we projected future measles CFRs through 2030.