Costs of continuing RTS,S/ASO1E malaria vaccination in the three malaria vaccine pilot implementation countries

Abstract

Background The RTS,S/ASO1E malaria vaccine is being piloted in three countries—Ghana, Kenya, and Malawi—as part of a coordinated evaluation led by the World Health Organization, with support from global partners. This study estimates the costs of continuing malaria vaccination upon completion of the pilot evaluation to inform decision-making and planning around potential further use of the vaccine in pilot areas. Methods We used an activity-based costing approach to estimate the incremental costs of continuing to deliver four doses of RTS,S/ASO1E through the existing Expanded Program on Immunization platform, from each government’s perspective. The RTS,S/ASO1E pilot introduction plans were reviewed and adapted to identify activities for costing. Key informant interviews with representatives from Ministries of Health (MOH) were conducted to inform the activities, resource requirements, and assumptions that, in turn, inform the analysis. Both financial and economic costs per dose, cost of delivery per dose, and cost per fully vaccinated child (FVC) are estimated and reported in 2017 USD units. Results At a vaccine price of $5 per dose and assuming the vaccine is donor-funded, our estimated incremental financial costs range from $1.70 (Kenya) to $2.44 (Malawi) per dose, $0.23 (Malawi) to $0.71 (Kenya) per dose delivered (excluding procurement add-on costs), and $11.50 (Ghana) to $13.69 (Malawi) per FVC. Estimates of economic costs per dose are between three and five times higher than financial costs. Variations in activities used for costing, procurement add-on costs, unit costs of per diems, and allowances contributed to differences in cost estimates across countries. Conclusion Cost estimates in this analysis are meant to inform country decision-makers as they face the question of whether to continue malaria vaccination, should the intervention receive a positive recommendation for broader use. Additionally, important cost drivers for vaccine delivery are highlighted, some of which might be influenced by global and country-specific financing and existing procurement mechanisms. This analysis also adds to the evidence available on vaccine delivery costs for products delivered outside the standard immunization schedule.

Examining the unit costs of COVID-19 vaccine delivery in Kenya

“…The largest costs driver was the costs to procure vaccines which contributed 39% to 79% of total financial costs and 58% to 70% of total economic costs across the different vaccination strategies. This is consistent with other vaccine costing studies for other diseases; For instance, a multi-country study done across Ghana, Kenya, and Malawi estimated that the costs of the malaria vaccine were up to 90% of the total financial and economic costs of continuing malaria vaccination after piloting [ 17 ]. The sensitivity analysis illustrated that the procurement costs of vaccines per person were sensitive to changes in vaccine prices illustrating the importance of procuring the COVID-19 vaccine at the lowest possible cost.…”

“…Previous evidence, that focused on total costs reported supply chain costs to be lower than immunization services for EPI vaccines in Kenya [ 18 ]. For malaria vaccine delivery in Kenya, evidence suggests that the recurrent cost drivers are social mobilization, service delivery, and monitoring and evaluation [ 17 ]. Training although expected to be a cost driver in our study, was among the least cost drivers in both the financial and economic vaccine delivery costs.…”

Optimizing next-generation RSV prevention in Mali: a cost-effectiveness analysis of pediatric vaccination, maternal vaccination, and extended half-life monoclonal antibody immunoprophylaxis

“…We assumed the price of the intervention product, $1.00 per dose in the base case for all strategies reflecting the published cost for the pentavalent vaccine (DTP-HepB-Hib) [24], would be subsidized by a donor with the national government paying $0.20 per dose. The government would also cover associated procurement, storage, and administration costs, assumed to be $0.67 per dose, reflecting the mean incremental cost of adding one product to the established immunization schedule in low-income countries [25]. Although there are no current childhood immunization visits at 6/7 months of age in Mali, the planned rollout of the RTS,S malaria vaccine will add these time points [26].…”

“…The government would also cover associated procurement, storage, and administration costs, assumed to be $0.67 per dose, reflecting the mean incremental cost of adding one product to the established immunization schedule in low-income countries [25]. Although there are no current childhood immunization visits at 6/7 months of age in Mali, the planned rollout of the RTS,S malaria vaccine will add these time points [26].…”

Vaccine dilemma for children at risk: Recently approved malaria vaccine versus ongoing COVID-19 vaccination campaign

“…Based on the economic dilemma of this situation, the RTS, S/AS01 vaccine is priced at $5 dollar per dose, and considering the fund received in low and middle-income countries the cost may vary from $0.7 to $2.5 per dose. The cost of a fully vaccinated child to the government would be $12 to $14 [ 12 ]. COVID-19 Vaccine which is available freely in most of the countries will pursue the parents to select the COVID-19 Vaccine over the malaria vaccine.…”