Public health impact and cost-effectiveness of the RTS,S/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models
The Lancet·
- DOI
- 10.1016/s0140-6736(15)00725-4
- PMID
- 26549466
- PMCID
- PMC4723722
- OpenAlex
- W2158417058
- Study type
- Randomised controlled trial
- Publisher
- Elsevier BV
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The models predict significant public health impact and high cost-effectiveness of RTS,S/AS01 vaccination across a wide range of malaria transmission settings in Africa, though implementation decisions would need to consider local burden levels, existing intervention coverage and cost-effectiveness, health priorities, financing, and delivery system capacity.
Structured evidence summary
Research question
The study assessed the public health impact and cost-effectiveness of routine RTS,S/AS01 malaria vaccine use in African settings across a range of transmission levels and timeframes beyond the phase 3 trial follow-up.
Study design
Four malaria transmission models were compared to project vaccine impact and cost-effectiveness over a 15-year horizon. Models were parameterized using phase 3 trial data from children aged 5-17 months with follow-up of 32 months or longer, examining two vaccination schedules across transmission settings with parasite prevalence in 2-10 year olds ranging from 3% to 65%.
Population and setting
The analysis targeted African settings with varying Plasmodium falciparum malaria transmission intensity, characterized by parasite prevalence in 2-10 year olds from 3% to 65%. Vaccine schedules considered were a three-dose regimen at 6, 7.5, and 9 months (90% coverage) and a four-dose regimen adding a dose at 27 months (72% coverage).
Main findings
In moderate to high transmission areas (parasite prevalence 10-65%), the vaccine was predicted to avert a median of 93,940 clinical cases and 394 deaths per 100,000 fully vaccinated children with three doses, or 116,480 cases and 484 deaths with four doses. The median incremental cost-effectiveness ratio at $5 per dose was $30 per clinical case averted and $80 per DALY averted for the three-dose schedule, with similar estimates for four doses. Positive impact was predicted at 5-10% prevalence, but minimal impact was seen below 3%.
Public-health relevance
The models predict significant public health impact and high cost-effectiveness of RTS,S/AS01 vaccination across a wide range of malaria transmission settings in Africa, though implementation decisions would need to consider local burden levels, existing intervention coverage and cost-effectiveness, health priorities, financing, and delivery system capacity.
Important limitations
This summary relies on the supplied single-article abstract and metadata. The original paper is required for decision-grade interpretation, including details on model assumptions, uncertainty quantification, sensitivity analyses, and how model predictions differed from one another.
GIDS interpretation
This article was identified through classifier links for malaria, Plasmodium falciparum malaria, vaccination topics, and health policy. It represents a modeling study projecting vaccine impact rather than surveillance or outbreak data, and is discoverable for researchers examining malaria vaccine implementation evidence.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 11 auditable classifier relationships to diseases, places, topics, and study design.