A new modeling study in PLOS Global Public Health found that using a neonatal rotavirus vaccine offered a more cost-effective alternative to Malawi’s current two-dose Rotarix vaccine schedule, while adding a third dose to the current strategy also provides substantial benefits. The study aimed to identify the optimal rotavirus vaccination strategy for Malawi by modeling vaccine impact and cost-effectiveness from the government and societal perspectives, comparing the current schedule to two alternative vaccine delivery schedules and a next-generation neonatal vaccine (RV3-BB) from 2025-2034.
Over a ten-year time horizon, the current two-dose Rotarix strategy is predicted to avert over 1.5 million cases and 90,000 disability-adjusted life-years (DALYs) compared to no vaccination and is cost-effective at willingness-to-pay (WTP) thresholds above $105 per DALY averted from the government perspective. Adding a third dose at 14 weeks could avert an additional 1 million cases and 38,000 DALYs, while switching to the neonatal vaccine could avert 1.1 million cases and 41,000 DALYs compared to the current strategy.
Adding a third dose of Rotarix would cost $4.1-4.9 million, while switching to the neonatal vaccine is expected to save $3.7 million compared to the current strategy. Considering the neonatal vaccine is not yet available, adding a third dose of Rotarix at 14 weeks of age is cost-effective at WTP thresholds above $138 per DALY averted.
How can the findings be used?
As decision-makers consider new vaccine strategies to improve rotavirus prevention efforts, these results can inform how employing innovative vaccine strategies may provide additional impact and be cost-effective in Malawi. This country-level analysis also provides a framework for considering new vaccine options where a program is already in place.
Thumbnail image credit: Shutterstock / Kateryna Kon
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