Adoption of RTS, S malaria vaccine for children younger than 5 years in Rwanda: A budget impact analysis

Cyrille Ndikumukiza; Ismaeel Yunusa; Joseph Nkurunziza; Eric Chinaeke; Fahad Hezam Alshammari; Egide Abahuje; Saud Alsahali

doi:10.1016/j.rcsop.2021.100063

Adoption of RTS, S malaria vaccine for children younger than 5 years in Rwanda: A budget impact analysis

Explor Res Clin Soc Pharm. 2021 Aug 16:3:100063. doi: 10.1016/j.rcsop.2021.100063. eCollection 2021 Sep.

Authors

Cyrille Ndikumukiza¹, Ismaeel Yunusa², Joseph Nkurunziza¹, Eric Chinaeke², Fahad Hezam Alshammari³, Egide Abahuje⁴, Saud Alsahali⁵

Affiliations

¹ Analyda LLC, Boston, MA, United States of America.
² College of Pharmacy, University of South Carolina, Columbia, SC, United States of America.
³ Ministry of Health, Saudi Arabia.
⁴ Simulation Education Fellow, STRATUS Center for Medical Simulation Brigham and Women's Hospital, Boston, MA, United States of America.
⁵ Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Qassim, Saudi Arabia.

Abstract

Background: In Rwanda, malaria affects one in six children under five years old. Despite being preventable and treatable, malaria causes substantial morbidity, mortality, and economic burden on the Rwandan government and healthcare donors. Recently, the World Health Organization (WHO) agreed to consider the new malaria vaccine (RTS, S) as an additional prevention strategy. The Global Fund, a healthcare donor, is committed to donating more than fifty million US dollars over four years (2018-2021) to fight malaria in Rwanda. We estimated the potential budget impact of the adoption of RTS, S, into the Global Fund budget (as a case study) for malaria prevention in Rwanda.

Methods: We developed a static budget impact model based on clinical, epidemiological, and cost (in US dollars) data from the literature, to assess the financial consequences of adding RTS, S to existing prevention strategies. Cost of treatment and prevention for the first year (without vaccine) was estimated and compared to the total cost after the fifth year (with vaccine). A one-way sensitivity analysis evaluated the robustness of the model.

Results: For the 283,931children under 5 years at risk of malaria in Rwanda every year, the expected budget for first year (without vaccine) was $1,328,377.71 and for the fifth year (with vaccine) was $3,837,804, yielding a potential budget impact of $2,509,427. The cost of treating un-prevented malaria for the first year was $736,959 and for the fifth year was $61,413. The annual number of malaria treatments avoided increased from 10,095 children in the first year after introduction of vaccine to 36,701 children at the fifth year.

Conclusion: With a potential budget impact of $2,509,427, the introduction of malaria vaccine for children under 5 years by Global Fund in Rwanda may be affordable when compared to the amount spent on treating children with malaria. Given that Malaria causes more harm than most parasitic diseases and disproportionally affects low-income populations, it is ethical to deploy all measures to control or eliminate Malaria, including vaccination.

Keywords: Budget impact; Children; Malaria; RTS, S; Rwanda; Vaccine.