Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

BackgroundMicroarray patches are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes. To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and resulting cost-effectiveness of introducing measles-rubella microarray patches (MR-MAPs) in 70 low- and middle-income countries (LMICs). MethodsWe used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths, and disability-adjusted life years during 20302040. Compared to the baseline scenarios with continuing current needle-based immunisation practice, we evaluated the introduction of MR-MAPs under different assumptions on measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement, and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs. ResultsMR-MAPs introduction could prevent 27%37% of measles burden between 20302040 in 70 LMICs. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Cost of measles treatment is a key driver of the net cost of introduction. In LMICs with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduction in measles treatment costs. Compared to country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 1681% of LMICs, depending on the MR-MAPs procurement price and vaccine coverage projections. ConclusionsIntroducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach under-vaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination.