Wenger Catherine, Asare Ernest O, Kwon Jiye, Li Xiao, Mwinjiwa Edson, Chinkhumba Jobiba, Jere Khuzwayo C, Hungerford Daniel, Cunliffe Nigel A, Paltiel A David, Pitzer Virginia E
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
PLOS Glob Public Health. 2025 Apr 10;5(4):e0004341. doi: 10.1371/journal.pgph.0004341. eCollection 2025.
Rotavirus is the leading cause of severe diarrhea among children under five worldwide, especially in low- and middle-income countries (LMICs). Although vaccination is the best strategy to prevent rotavirus, obstacles leading to poor vaccine effectiveness undermine its impact in LMICs. This study aimed to identify the optimal rotavirus vaccination strategy for Malawi by modeling vaccine impact and cost-effectiveness, comparing the current two-dose Rotarix vaccine schedule to two alternative vaccine delivery schedules and a next-generation neonatal vaccine (RV3-BB) from 2025-2034. The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated from the government and societal perspectives using estimates of moderate-to-severe and non-severe rotavirus cases derived from a transmission dynamic model of rotavirus and published estimates of health-seeking behaviors and costs as inputs. A probabilistic sensitivity analysis was performed to evaluate the robustness of our results to parameter uncertainty. 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 RV3-BB vaccine could avert 1.1 million cases and 41,000 DALYs compared to the current strategy. Whereas adding a third dose of Rotarix would cost $4.1-4.9 million, 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. The neonatal vaccine offers a more cost-effective alternative to Malawi's current rotavirus vaccine, while adding a third dose to the current strategy also provides substantial benefits.
轮状病毒是全球五岁以下儿童严重腹泻的主要病因，在低收入和中等收入国家（LMICs）尤为如此。尽管接种疫苗是预防轮状病毒的最佳策略，但导致疫苗效力不佳的障碍削弱了其在低收入和中等收入国家的影响。本研究旨在通过模拟疫苗影响和成本效益，为马拉维确定最佳的轮状病毒疫苗接种策略，将当前的两剂Rotarix疫苗接种方案与两种替代疫苗接种方案以及2025年至2034年的下一代新生儿疫苗（RV3-BB）进行比较。从政府和社会角度，利用从轮状病毒传播动力学模型得出的中度至重度和非重度轮状病毒病例估计数以及已发表的就医行为和成本估计数作为输入，评估了马拉维轮状病毒疫苗策略的成本效益。进行了概率敏感性分析，以评估我们的结果对参数不确定性的稳健性。在十年时间范围内，与不接种疫苗相比，目前的两剂Rotarix策略预计可避免超过150万例病例和90,000个伤残调整生命年（DALYs），从政府角度来看，在每避免一个DALY支付意愿（WTP）阈值高于105美元时具有成本效益。在14周龄时增加第三剂可额外避免100万例病例和38,000个DALYs，而与当前策略相比，改用新生儿RV3-BB疫苗可避免110万例病例和41,000个DALYs。虽然增加第三剂Rotarix的成本为410万至490万美元，但与当前策略相比，改用新生儿疫苗预计可节省370万美元。考虑到新生儿疫苗尚未可用，在14周龄时增加第三剂Rotarix在每避免一个DALY支付意愿阈值高于138美元时具有成本效益。新生儿疫苗为马拉维目前的轮状病毒疫苗提供了更具成本效益的替代方案，而在当前策略中增加第三剂也能带来显著益处。
