伤寒结合疫苗的微阵列贴片疫苗：全球成本效益分析

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2025-04-03 DOI:10.1016/j.vaccine.2025.127055

Marina Antillon , Anna Verjans , Fayad El Sheikh , Tiziana Scarna , Mercy Mvundura

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引用次数: 0

摘要

一种新型伤寒结合疫苗（TCV），即微阵列贴片（MAP），正处于早期开发阶段，可能有助于提高在难以接触到的人群中的覆盖率，超过目前用针和注射器给药的小瓶TCV （TCV- n&；S）。然而，TCV-MAPs每剂量的价格可能高于tcv - n & &；S。我们的分析评估了TCV-MAPs与TCV-N&；S联合使用的潜在成本效益，与单独使用TCV-N&；S相比。从卫生保健的角度，对133个低收入至中高收入国家进行了为期20年（2033-2052年）的全球扩展成本效益分析。健康结果以残疾调整生命年（DALYs）表示，成本以2021美元表示，均以3%折现。我们假设TCV-MAP的价格是TCV-N&；S疫苗价格的1.33到3倍。我们计算了增量成本效益比，并根据不同的成本效益阈值对其进行了评估。对于五个选定的国家，我们进行了额外的次国家分析，以了解具体地区实施TCV-MAP而不是全国推广的潜在价值。在133个低收入和中高收入国家中，与仅采用tcv - n - S相比，在全国范围内推广tcv - map可避免520万例病例、4.7万例死亡和240万伤残调整生命年，在20年内额外花费35亿美元。避免负担的最大比例将在撒哈拉以南非洲区域。TCV-MAPs在33%的国家具有成本效益，但在78%的撒哈拉以南非洲国家具有成本效益。次国家层面的实施可使一些国家受益，因为国家层面的实施可能不具有成本效益，与国家层面的推广相比，可避免2 - 15%的病例，而额外费用不到1 - 3%。MAP价格是结果的关键驱动因素。区域或地方实施，加上较低的价格点，可以显著改善TCV-MAP的价值主张。

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Microarray patch vaccines for typhoid conjugate vaccines: A global cost-effectiveness analysis

A novel typhoid conjugate vaccine (TCV) presentation, the microarray patch (MAP), is in early-stage development and could potentially help to increase coverage in hard-to-reach populations beyond what is being achieved with the current TCV in a vial presentation administered with a needle and syringe (TCV-N&S). However, TCV-MAPs may come at a higher price per dose than TCV-N&S. Our analysis evaluated the potential cost-effectiveness of TCV-MAPs alongside TCV-N&S compared to TCV-N&S alone.

A global extended cost-effectiveness analysis, taking a health care perspective, was conducted for 133 low- to upper-middle-income countries for a time horizon of 20 years (2033–2052). Health outcomes were expressed in disability-adjusted life years (DALYs) and costs in 2021 US dollars, both discounted at 3 %. We assumed TCV-MAP would cost 1.33 to 3 times the price of the TCV-N&S vaccine. We calculated incremental cost-effectiveness ratios and evaluated them against various cost-effectiveness thresholds. For five selected countries, we conducted an additional subnational analysis to understand the potential value of a district-specific TCV-MAP implementation instead of a national rollout.

Across the 133 low- to upper-middle-income countries, national rollout of TCV-MAPs could avert an additional 5.2 million cases, 47,000 deaths, and 2.4 million DALYs compared to TCV-N&S only, at an additional cost of US$3.5 billion over 20 years. The largest proportion of the averted burden would be in the sub-Saharan African region. TCV-MAPs could be cost-effective in 33 % of the countries but in 78 % of sub-Saharan African countries. A subnational implementation could benefit some countries for which a national implementation may not be cost-effective, averting 2–15 % of cases for less than 1–3 % of the additional cost as compared to a national rollout. MAP price was a key driver of the results.

Regional or subnational implementation, coupled with a lower price point, could significantly improve the TCV-MAP value proposition.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

期刊介绍： Vaccine is unique in publishing the highest quality science across all disciplines relevant to the field of vaccinology - all original article submissions across basic and clinical research, vaccine manufacturing, history, public policy, behavioral science and ethics, social sciences, safety, and many other related areas are welcomed. The submission categories as given in the Guide for Authors indicate where we receive the most papers. Papers outside these major areas are also welcome and authors are encouraged to contact us with specific questions.