Center for Vaccine Innovation and Access, PATH, Seattle, USA.
Levin and Morgan LLC, Maryland, USA.
Vaccine. 2023 Feb 17;41(8):1496-1502. doi: 10.1016/j.vaccine.2023.01.043. Epub 2023 Jan 27.
The World Health Organization (WHO) recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children residing in regions of moderate to high malaria transmission. This recommendation is informed by RTS,S evidence, including findings from the pilot rollout of the vaccine in Ghana, Kenya, and Malawi. This study estimates the incremental costs of introducing and delivering the malaria vaccine within routine immunization programs in the context of malaria vaccine pilot introduction, to help inform decision-making.
An activity-based, retrospective costing was conducted from the governments' perspective. Vaccine introduction and delivery costs supported by the donors during the pilot introduction were attributed as costs to the governments under routine implementation. Detailed resource use data were extracted from the pilot program expenditure and activity reports for 2019-2021. Primary data from representative health facilities were collected to inform recurrent operational and service delivery costs.Costs were categorized as introduction or recurrent costs. Both financial and economic costs were estimated and reported in 2020 USD. The cost of donated vaccine doses was evaluated at $2, $5 and $10 per dose and included in the economic cost estimates. Financial costs include the procurement add on costs for the donated vaccines and immunization supplies, along with other direct expenses.
At a vaccine price of $5 per dose, the incremental cost per dose administered across countries ranges from $2.30 to $3.01 (financial), and $8.28 to $10.29 (economic). The non-vaccine cost of delivery ranges between $1.04 and $2.46 (financial) and $1.52 and $4.62 (economic), by country. Considering only recurrent costs, the non-vaccine cost of delivery per dose ranges between $0.29 and $0.89 (financial) and $0.59 and $2.29 (economic), by country. Introduction costs constitute between 33% and 71% of total financial costs. Commodity and procurement add-on costs are the main cost drivers of total cost across countries. Incremental resource needs for implementation are dependent on country's baseline immunization program capacity constraints.
The financial costs of introducing RTS,S are comparable with costs of introducing other new vaccines. Country resource requirements for malaria vaccine introduction are most influenced by vaccine price and potential donor funding for vaccine purchases and introduction support.
世界卫生组织（WHO）建议在疟疾中度至高度传播地区居住的儿童广泛使用 RTS,S/AS01（RTS,S）疟疾疫苗。这一建议是基于 RTS,S 的证据得出的，包括该疫苗在加纳、肯尼亚和马拉维进行试点推广的结果。本研究估算了在疟疾疫苗试点推广背景下，将该疫苗纳入常规免疫规划的新增成本，以帮助决策。
从政府的角度进行了基于活动的回溯性成本核算。在试点推广期间，由捐助者支持的疫苗引入和交付成本被归因于政府在常规实施下的成本。从 2019-2021 年的试点项目支出和活动报告中提取了详细的资源使用数据。从有代表性的卫生机构收集了新的运营和服务提供成本数据。成本分为引入成本或经常性成本。同时估算并报告了财务和经济成本，均以 2020 年美元计价。评估了每剂 2 美元、5 美元和 10 美元的捐赠疫苗剂量的成本，并将其纳入经济成本估算。财务成本包括用于捐赠疫苗和免疫接种用品的采购附加成本以及其他直接费用。
在每剂 5 美元的疫苗价格下，各国每剂接种的增量成本在 2.30 美元至 3.01 美元（财务）和 8.28 美元至 10.29 美元（经济）之间。按国家划分，非疫苗接种成本在 1.04 美元至 2.46 美元（财务）和 1.52 美元至 4.62 美元（经济）之间。仅考虑经常性成本，各国每剂非疫苗接种成本在 0.29 美元至 0.89 美元（财务）和 0.59 美元至 2.29 美元（经济）之间。引入成本占总财务成本的 33%至 71%。商品和采购附加成本是各国总成本的主要成本驱动因素。实施所需的增量资源取决于国家基线免疫规划能力的限制。
引入 RTS,S 的财务成本与引入其他新疫苗的成本相当。国家引入疟疾疫苗的资源需求受疫苗价格和潜在捐助者为疫苗采购和引入支持提供资金的影响最大。
