Cost-Effective Threshold Price for Alternative Infant and Neonatal Rotavirus Vaccines: A Dual-Country Evaluation

This preprint study evaluates the cost-effectiveness of alternative infant and neonatal rotavirus vaccination strategies in Malawi and Ghana, with a particular focus on the neonatal RV3-BB vaccine candidate. The analysis used a dynamic transmission model and full incremental cost-effectiveness framework to compare current national immunization programmes with alternative schedules, including Rotarix, Rotavac, and neonatal RV3-BB vaccination. The study explored how vaccine price, duration of protection, and implementation costs influence the optimal vaccination strategy in two Gavi-supported African countries with different financing and vaccine transition contexts.

Key findings and insights

• Introducing the neonatal RV3-BB vaccine produced the largest reductions in rotavirus disease burden in both countries, reducing moderate-to-severe cases by 18% in Malawi and 25% in Ghana compared with current programmes.
• At base-case assumptions, RV3-BB was associated with substantial health gains and cost savings, averting approximately 44,000 DALYs in Malawi and 87,000 DALYs in Ghana over 2025–2034.
• RV3-BB was more likely to be the preferred strategy at moderate willingness-to-pay thresholds, particularly when vaccine prices remained low and protection lasted longer than approximately 40 weeks.
• Suspending rotavirus vaccination substantially increased disease burden and mortality in both countries, despite appearing cost-saving at very low willingness-to-pay thresholds.
• The study identified uncertainty around vaccine delivery costs, RV3-BB pricing, and duration of protection as major drivers of decision uncertainty, highlighting the importance of additional evidence generation for next-generation rotavirus vaccines.

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