2024-02-09 インペリアル・カレッジ・ロンドン(ICL)
◆この研究は、15年間の期間で、ワクチン接種100,000人あたりに対し、季節的なマラリア地域では200,000件の症例と650件の死亡を防ぎ、年間マラリア伝播地域では180,000件の症例と630件の死亡を防ぐと推定しています。また、このワクチンの導入は、予測モデルによれば、アフリカのマラリア流行地域で大きな公衆衛生上の影響をもたらす可能性があります。
<関連情報>
- https://www.imperial.ac.uk/news/251218/new-malaria-vaccine-substantial-public-health/
- https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00816-2/fulltext
R21/Matrix-Mマラリアワクチンの公衆衛生への影響と費用対効果:数理モデリング研究 The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study
Nora Schmit, PhD ;Hillary M Topazian, PhD ;H Magloire Natama, PhD;Duncan Bellamy, MSc;Ousmane Traoré, PhD;M Athanase Somé, MD;et al.
The Lancet infection infection Published:February 08, 2024
DOI:https://doi.org/10.1016/S1473-3099(23)00816-2
Summary
Background
The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum clinical malaria in children in sub-Saharan Africa. Using trial data, we aimed to estimate the public health impact and cost-effectiveness of vaccine introduction across sub-Saharan Africa.
Methods
We fitted a semi-mechanistic model of the relationship between anti-circumsporozoite protein antibody titres and vaccine efficacy to data from 3 years of follow-up in the phase 2b trial of R21/Matrix-M in Nanoro, Burkina Faso. We validated the model by comparing predicted vaccine efficacy to that observed over 12–18 months in the phase 3 trial. Integrating this framework within a mathematical transmission model, we estimated the cases, malaria deaths, and disability-adjusted life-years (DALYs) averted and cost-effectiveness over a 15-year time horizon across a range of transmission settings in sub-Saharan Africa. Cost-effectiveness was estimated incorporating the cost of vaccine introduction (dose, consumables, and delivery) relative to existing interventions at baseline. We report estimates at a median of 20% parasite prevalence in children aged 2–10 years (PfPR2–10) and ranges from 3% to 65% PfPR2–10.
Findings
Anti-circumsporozoite protein antibody titres were found to satisfy the criteria for a surrogate of protection for vaccine efficacy against clinical malaria. Age-based implementation of a four-dose regimen of R21/Matrix-M vaccine was estimated to avert 181 825 (range 38 815–333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868–405 702) clinical cases per 100 000 fully vaccinated children in seasonal settings. Similar estimates were obtained for seasonal or hybrid implementation. Under an assumed vaccine dose price of US$3, the incremental cost per clinical case averted was $7 (range 4–48) in perennial settings and $6 (3–63) in seasonal settings and the incremental cost per DALY averted was $34 (29–139) in perennial settings and $30 (22–172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PfPR2–10.
Interpretation
Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa.
Funding
The Wellcome Trust, the Bill & Melinda Gates Foundation, the UK Medical Research Council, the European and Developing Countries Clinical Trials Partnership 2 and 3, the NIHR Oxford Biomedical Research Centre, and the Serum Institute of India, Open Philanthropy.
