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Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa
  1. Peter Winskill1,
  2. Patrick GT Walker1,
  3. Jamie T Griffin1,2,
  4. Azra C Ghani1
  1. 1Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
  2. 2School of Mathematical Sciences, Queen Mary University of London, London, UK
  1. Correspondence to Dr Peter Winskill; p.winskill{at}


Objectives To evaluate the relative cost-effectiveness of introducing the RTS,S malaria vaccine in sub-Saharan Africa compared with further scale-up of existing interventions.

Design A mathematical modelling and cost-effectiveness study.

Setting Sub-Saharan Africa.

Participants People of all ages.

Interventions The analysis considers the introduction and scale-up of the RTS,S malaria vaccine and the scale-up of long-lasting insecticide-treated bed nets (LLINs), indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC).

Main outcome measure The number of Plasmodium falciparum cases averted in all age groups over a 10-year period.

Results Assuming access to treatment remains constant, increasing coverage of LLINs was consistently the most cost-effective intervention across a range of transmission settings and was found to occur early in the cost-effectiveness scale-up pathway. IRS, RTS,S and SMC entered the cost-effective pathway once LLIN coverage had been maximised. If non-linear production functions are included to capture the cost of reaching very high coverage, the resulting pathways become more complex and result in selection of multiple interventions.

Conclusions RTS,S was consistently implemented later in the cost-effectiveness pathway than the LLINs, IRS and SMC but was still of value as a fourth intervention in many settings to reduce burden to the levels set out in the international goals.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Handling editor Sanni Yaya.

  • Contributors PW prepared and performed the analysis and drafted the manuscript. PW, PGTW, JTG and ACG contributed to conceiving and designing the analysis and writing the final draft. PGTW, JTG and ACG contributed to analysis and interpretation of the data. PW is the corresponding author.

  • Funding The Bill & Melinda Gates Foundation (PW, ACG), UK Medical Research Council fellowships (PGTW, JTG), Malaria Vaccine Initiative (JTG and ACG) and MRC Centre Funding + DFID (all).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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