Cost-effectiveness analysis of a hypothetical vaccine for schistosomiasis in Madagascar and Burkina Faso

BACKGROUND:

Schistosomiasis, a major neglected tropical disease, affects millions of people worldwide. Although mass drug administration with praziquantel remains the primary control strategy, vaccines are currently under development and may provide an additional tool for disease prevention. This study evaluated the cost-effectiveness of alternative schistosomiasis vaccination strategies in Madagascar and Burkina Faso to support future policy decisions.

METHODS:

A Markov model was developed to estimate the health and economic outcomes associated with schistosomiasis. Incremental cost-effectiveness ratios were estimated using the country-specific cost of illness and health-related quality-of-life data obtained from field-based studies in Madagascar and Burkina Faso. Multiple vaccination strategies and hypothetical vaccine profiles with varying efficacy and duration of protection were evaluated and compared with a no-vaccination scenario.

RESULTS:

Vaccination strategies targeting only school-aged children were generally not cost-effective under the base-case assumptions. Extending vaccination to adults substantially improved cost-effectiveness in both countries because age-specific prevalence remained higher among adults than among school-aged children in both countries, allowing vaccination strategies including adults to capture a larger share of the remaining disease burden. In Madagascar, the RT3CU4-59 strategy was associated with an ICER of US$278 per quality-adjusted life year gained. In Burkina Faso, the same strategy was dominant, generating additional quality-adjusted life years while reducing overall costs compared with no vaccination. Cost-effectiveness was influenced more strongly by the duration of protection than by vaccine efficacy and was also sensitive to the cost per fully immunized person.

CONCLUSIONS:

Schistosomiasis vaccination has the potential to be a cost-effective intervention, although its economic value depends strongly on vaccine characteristics, implementation costs, and the target population. Vaccination strategies including adults may provide greater health and economic benefits, particularly in settings with a high adult disease burden or high treatment costs for severe disease.