ranju baral - Academia.edu (original) (raw)

Papers by ranju baral

Research paper thumbnail of Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children: a decision-support model for use in low-income and middle-income countries

BMC Medicine

Background Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young c... more Background Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young children. A number of mathematical models have been used to assess the cost-effectiveness of RSV prevention strategies, but these have not been designed for ease of use by multidisciplinary teams working in low-income and middle-income countries (LMICs). Methods We describe the UNIVAC decision-support model (a proportionate outcomes static cohort model) and its approach to exploring the potential cost-effectiveness of two RSV prevention strategies: a single-dose maternal vaccine and a single-dose long-lasting monoclonal antibody (mAb) for infants. We identified model input parameters for 133 LMICs using evidence from the literature and selected national datasets. We calculated the potential cost-effectiveness of each RSV prevention strategy (compared to nothing and to each other) over the lifetimes of all children born in the year 2025 and compared our results to a separate model publishe...

Research paper thumbnail of Cost of childhood RSV management and cost-effectiveness of RSV interventions: a systematic review from a low- and middle-income country perspective

BMC Medicine

Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countrie... more Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countries (LMICs). Until recently, the only licensed preventive intervention has been a shortacting monoclonal antibody (mAb), palivizumab (PVZ) that is expensive and intensive to administer, making it poorly suited for low-resource settings. Currently, new longer acting RSV mAbs and maternal vaccines are emerging from late-stage clinical development with promising clinical effectiveness. However, evidence of economic value and affordability must also be considered if these interventions are to be globally accessible. This systematic review’s objective was to summarise existing evidence on the cost-of-illness (COI) and cost-effectiveness of RSV prevention interventions in LMICs. Methods We conducted a systematic literature review using the Embase, MEDLINE, and Global Index Medicus databases for publications between Jan 2000 and Jan 2022. Two categories of studies in LMICs were targeted: cost-of-...

Research paper thumbnail of Cost of introducing and delivering RTS,S/AS01 malaria vaccine within the malaria vaccine implementation program

Research paper thumbnail of MOESM1 of Costs and cost-effectiveness of malaria reactive case detection using loop-mediated isothermal amplification compared to microscopy in the low transmission setting of Aceh Province, Indonesia

Additional file 1: Figure S1. Cost proportion breakdown of capital costs. Table S1. Detailed summ... more Additional file 1: Figure S1. Cost proportion breakdown of capital costs. Table S1. Detailed summary of input costs (USD) by location. Table S2. Detailed summary of input costs (USD) by cost category. Table S3. Detailed list of top ten capital costs, discounted annually at 3% from year of purchase (USD).

Research paper thumbnail of Additional file 6 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 6. Comparison of modelled and empirical estimates of direct medical costs across ... more Additional file 6. Comparison of modelled and empirical estimates of direct medical costs across countries.

Research paper thumbnail of An Average Cost Effectiveness Analysis of the EFNEP Effects

Research paper thumbnail of An Investment Case for Eliminating Malaria in Indonesia

Research paper thumbnail of Evaluating the Costs and Cost-Effectiveness of Microscopy Compared to Lamp Used During Reactive Case Detection in Aceh Province, Indonesia

American Journal of Tropical Medicine and Hygiene, 2017

Research paper thumbnail of The economic burden of noncommunicable diseases on America’s youth: an analysis of children’s healthcare spending in the United States from 1996-2012

Annals of Global Health, 2016

Research paper thumbnail of Cost Effectiveness of Nutrition Education Programs for Limited Resource Youth

Journal of Nutrition Education and Behavior, 2013

Research paper thumbnail of time elasticity of substitution-Consumption time in household production: Implications for the goods

Research paper thumbnail of Additional file 2 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 2. Diarrhea cost of illness (2015 USD) from literature by level of facility.

Research paper thumbnail of Evaluation of the Youth Expanded Food and Nutrition Education Program: What Contributes to its Effectiveness?

Background Evaluation of federally funded programs is important to improve their effectiveness an... more Background Evaluation of federally funded programs is important to improve their effectiveness and to ensure their public accountability (General Accounting Office [GAO] 2004). USDA provides funds and manages the Expanded Food and Nutrition Education Program (EFNEP). Every year, EFNEP spends over 66 million US dollars (68 million in 2010) of federal budget (NIFA, 2011). There has been an increased emphasis on the evaluation of federally funded programs to improve the effectiveness and public accountability of the federal programs (GAO 2004). Despite being one of the largest and longest (in operation for more than 40 years and implemented in all 50 states and six US territories) nutrition education programs in the US (GAO 2004), its evaluation has been sparse and its effectiveness largely unknown. EFENP is designed to serve the limited resource audiences, both adults and youths, by helping them acquire “the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and improvement of the overall family diet and nutritional well-being” (USDA 2011). According to the USDA‟s annual impact report of EFNEP, the participants have shown improvements in different domains of nutrition behavior (USDA 2011). Effectiveness of EFNEP for adults is substantiated by several studies that have appeared in the peer reviewed journal (Arnold and Sobal 2000; Rajgopal et al. 2002; Dollahite et al. 2008). Although youths comprise a large portion, more than 75% of EFNEP beneficiaries, evaluations of youth EFNEP have largely remain undocumented. Townsend and colleagues (2006) are only scholars to study the effectiveness of youth EFNEP. By using USDA‟s selected youth impact indicators as outcome measures, they found that the participants who received the lessons had higher post-test scores than the counterparts. Routine evaluation of the Youth EFNEP by USDA is primarily based on the number of youths who improve in any of the following four impact indicators: (i) increase in variety of foods they eat; (ii) increase in nutritional knowledge; (iii) increase in ability to select low-cost, nutritious food; and (iv) improvement in food preparation and safety practices. Part of the reason for the scantiness in evaluation studies on youth EFNEP is due to the lack of valid and reliable assessment tools. No federal guideline mandates the use of any specific instrument or even curricula for youth EFNEP. For evaluation, the state program often creates their own survey instruments. This results in the lack of consistency and standardization across EFNEP program evaluation. Recently, a concerted effort has been made to develop a standardized instrument to measure the outcomes of the youth EFNEP. This effort was a part of the larger project on the cost effectiveness of youth EFNEP and the process was closely monitored and guided by the “advisory board” that consists of nationally recognized faculty with expertise in nutrition, EFNEP, economics, item response theory, and program evaluation. We utilize the data collected using this instrument to evaluate effectiveness of the youth EFNEP in Virginia. In particular, we attempt to measure the outcomes of the youth EFNEP program and to explore the factors that contribute to the effectiveness of the program. We take an item theoretic approach and applied a Rasch measurement model 1 to measure program outcomes. Application of the Rasch measurement model is novel in the current context, and is an improvement over the outcome measure in practice by USDA. Using the Rasch outcome scores as a dependent variable, we

Research paper thumbnail of Additional file 5 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 5. Modelled cost of illness (2015 USD) estimates by country, excluding cost assoc... more Additional file 5. Modelled cost of illness (2015 USD) estimates by country, excluding cost associated with oral rehydrated solution (ORS).

Research paper thumbnail of Additional file 3 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 3. Modelled cost of illness (2015 USD) estimates by country, using WHO-CHOICE ser... more Additional file 3. Modelled cost of illness (2015 USD) estimates by country, using WHO-CHOICE service delivery unit cost estimates.

Research paper thumbnail of Returns to Scale and the Effectiveness of Money Spent on the Expanded Food and Nutrition Education Program

In operation for more than 40 years and now in all 50 states and 6 territories, the Expanded Food... more In operation for more than 40 years and now in all 50 states and 6 territories, the Expanded Food and Nutrition Education Program has become a cornerstone in US nutrition education. The aim of the program is to assist limited resource audiences to acquire the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and improvement of the overall family diet and nutritional well-being. However, very little is known about the effectiveness of this program, especially at the national level. The purpose of this research is to determine the effectiveness of money spent on the Expanded Food and Nutrition Education Program in satisfying its stated goals for adult participants. Data from all states and territories participating in the program for the years 2000-2006 are utilized in a non-linear seemingly unrelated regression framework to estimate returns to scale and related cost measures. Controlling for par...

Research paper thumbnail of The Cost Effectiveness of Educating Limited Resource Youths on Food and Nutrition

Agricultural and Applied Economics Association, 2013

A framework for estimating cost effectiveness of the youth Expanded Food and Nutrition Education ... more A framework for estimating cost effectiveness of the youth Expanded Food and Nutrition Education Program (EFNEP), one of the largest nutrition education programs in the US, is developed. Using costs and effects data from 15 program counties in Virginia for the school year 2011/2012, the cost effectiveness ratio (CER) of the Healthy Weights for Healthy Kids (HWHK) program was estimated. Improvements in nutrition related behavior, and improvements in nutrition related self-efficacy, from pretest to posttest, were considered as two indicators of program effects. Direct costs associated with the provision of the HWHK program were considered program costs. The total cost of the program was estimated to be 134,333foroneyear.Among1,864participants,1,786improvedinbehaviorindicatorsand1,782improvedinself−efficacyindicators.TheestimatedCERisabout134,333 for one year. Among 1,864 participants, 1,786 improved in behavior indicators and 1,782 improved in self-efficacy indicators. The estimated CER is about 134,333foroneyear.Among1,864participants,1,786improvedinbehaviorindicatorsand1,782improvedinself−efficacyindicators.TheestimatedCERisabout75 per improvement for each outcome indicator. Cross county comparisons reveal a wide variation in CER estimates across counties. The results from this study provide the first piece of information on the CER for youth EFNEP which quantify the effects of investment on youth EFNEP program in Virginia in achieving the stated program objectives.

Research paper thumbnail of Expenditure and Health System Productivity by Disease and Injury in the US from 1996 to 2010

Research paper thumbnail of Evaluating the potential economic and health impact of rotavirus vaccination in 63 middle-income countries not eligible for Gavi funding: a modelling study

The Lancet Global Health, 2021

Background Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccin... more Background Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccine Alliance, have been slow to adopt rotavirus vaccines. Few studies have evaluated the cost-effectiveness and benefit-risk of rotavirus vaccination in these settings. We aimed to assess the potential economic and health impact of rotavirus vaccination in 63 MICs not eligible for funding from Gavi. Methods In this modelling study, we estimated the cost-effectiveness and benefit-risk of rotavirus vaccination in 63 MICs not eligible to Gavi funding. We used an Excel-based proportionate outcomes model with a finely disaggregated age structure to estimate the number of rotavirus gastroenteritis cases, clinic visits, hospitalisations, and deaths averted by vaccination in children younger than 5 years over a 10-year period. We calculated costeffectiveness ratios (costs per disability-adjusted life-years averted compared with no vaccination) and benefit-risk ratios (number of hospitalisations due to rotavirus gastroenteritis averted per excess hospitalisations due to intussusception). We evaluated three alternative vaccines available globally (Rotarix, Rotavac, and Rotasiil) and used information from vaccine manufacturers regarding anticipated vaccine prices. We ran deterministic and probabilistic uncertainty analyses. Findings Over the period 2020-29, rotavirus vaccines could avert 77 million (95% uncertainty interval [UI] 51-103) cases of rotavirus gastroenteritis and 21 million (12-36) clinic visits, 3 million (1•4-5•6) hospitalisations, and 37 900 (25 900-55 900) deaths due to rotavirus gastroenteritis in 63 MICs not eligible for Gavi support. From a government perspective, rotavirus vaccination would be cost-effective in 48 (77%) of 62 MICs considered. The benefit-risk ratio for hospitalisations prevented versus those potentially caused by vaccination exceeded 250:1 in all countries. Interpretation In most MICs not eligible for Gavi funding, rotavirus vaccination has high probability to be costeffective with a favourable benefit-risk profile. Policy makers should consider this new evidence when making or revisiting decisions on the use of rotavirus vaccines in their respective countries. Funding Bill & Melinda Gates Foundation.

Research paper thumbnail of Costs of continuing RTS,S/ASO1E malaria vaccination in the three malaria vaccine pilot implementation countries

PLOS ONE, 2021

Background The RTS,S/ASO1E malaria vaccine is being piloted in three countries—Ghana, Kenya, and ... more Background The RTS,S/ASO1E malaria vaccine is being piloted in three countries—Ghana, Kenya, and Malawi—as part of a coordinated evaluation led by the World Health Organization, with support from global partners. This study estimates the costs of continuing malaria vaccination upon completion of the pilot evaluation to inform decision-making and planning around potential further use of the vaccine in pilot areas. Methods We used an activity-based costing approach to estimate the incremental costs of continuing to deliver four doses of RTS,S/ASO1E through the existing Expanded Program on Immunization platform, from each government’s perspective. The RTS,S/ASO1E pilot introduction plans were reviewed and adapted to identify activities for costing. Key informant interviews with representatives from Ministries of Health (MOH) were conducted to inform the activities, resource requirements, and assumptions that, in turn, inform the analysis. Both financial and economic costs per dose, cos...

Research paper thumbnail of Cost-effectiveness of pharmaceutical strategies to prevent respiratory syncytial virus disease in young children: a decision-support model for use in low-income and middle-income countries

BMC Medicine

Background Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young c... more Background Respiratory syncytial virus (RSV) is a leading cause of respiratory disease in young children. A number of mathematical models have been used to assess the cost-effectiveness of RSV prevention strategies, but these have not been designed for ease of use by multidisciplinary teams working in low-income and middle-income countries (LMICs). Methods We describe the UNIVAC decision-support model (a proportionate outcomes static cohort model) and its approach to exploring the potential cost-effectiveness of two RSV prevention strategies: a single-dose maternal vaccine and a single-dose long-lasting monoclonal antibody (mAb) for infants. We identified model input parameters for 133 LMICs using evidence from the literature and selected national datasets. We calculated the potential cost-effectiveness of each RSV prevention strategy (compared to nothing and to each other) over the lifetimes of all children born in the year 2025 and compared our results to a separate model publishe...

Research paper thumbnail of Cost of childhood RSV management and cost-effectiveness of RSV interventions: a systematic review from a low- and middle-income country perspective

BMC Medicine

Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countrie... more Background Approximately 97% of global deaths due to RSV occur in low- and middle-income countries (LMICs). Until recently, the only licensed preventive intervention has been a shortacting monoclonal antibody (mAb), palivizumab (PVZ) that is expensive and intensive to administer, making it poorly suited for low-resource settings. Currently, new longer acting RSV mAbs and maternal vaccines are emerging from late-stage clinical development with promising clinical effectiveness. However, evidence of economic value and affordability must also be considered if these interventions are to be globally accessible. This systematic review’s objective was to summarise existing evidence on the cost-of-illness (COI) and cost-effectiveness of RSV prevention interventions in LMICs. Methods We conducted a systematic literature review using the Embase, MEDLINE, and Global Index Medicus databases for publications between Jan 2000 and Jan 2022. Two categories of studies in LMICs were targeted: cost-of-...

Research paper thumbnail of Cost of introducing and delivering RTS,S/AS01 malaria vaccine within the malaria vaccine implementation program

Research paper thumbnail of MOESM1 of Costs and cost-effectiveness of malaria reactive case detection using loop-mediated isothermal amplification compared to microscopy in the low transmission setting of Aceh Province, Indonesia

Additional file 1: Figure S1. Cost proportion breakdown of capital costs. Table S1. Detailed summ... more Additional file 1: Figure S1. Cost proportion breakdown of capital costs. Table S1. Detailed summary of input costs (USD) by location. Table S2. Detailed summary of input costs (USD) by cost category. Table S3. Detailed list of top ten capital costs, discounted annually at 3% from year of purchase (USD).

Research paper thumbnail of Additional file 6 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 6. Comparison of modelled and empirical estimates of direct medical costs across ... more Additional file 6. Comparison of modelled and empirical estimates of direct medical costs across countries.

Research paper thumbnail of An Average Cost Effectiveness Analysis of the EFNEP Effects

Research paper thumbnail of An Investment Case for Eliminating Malaria in Indonesia

Research paper thumbnail of Evaluating the Costs and Cost-Effectiveness of Microscopy Compared to Lamp Used During Reactive Case Detection in Aceh Province, Indonesia

American Journal of Tropical Medicine and Hygiene, 2017

Research paper thumbnail of The economic burden of noncommunicable diseases on America’s youth: an analysis of children’s healthcare spending in the United States from 1996-2012

Annals of Global Health, 2016

Research paper thumbnail of Cost Effectiveness of Nutrition Education Programs for Limited Resource Youth

Journal of Nutrition Education and Behavior, 2013

Research paper thumbnail of time elasticity of substitution-Consumption time in household production: Implications for the goods

Research paper thumbnail of Additional file 2 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 2. Diarrhea cost of illness (2015 USD) from literature by level of facility.

Research paper thumbnail of Evaluation of the Youth Expanded Food and Nutrition Education Program: What Contributes to its Effectiveness?

Background Evaluation of federally funded programs is important to improve their effectiveness an... more Background Evaluation of federally funded programs is important to improve their effectiveness and to ensure their public accountability (General Accounting Office [GAO] 2004). USDA provides funds and manages the Expanded Food and Nutrition Education Program (EFNEP). Every year, EFNEP spends over 66 million US dollars (68 million in 2010) of federal budget (NIFA, 2011). There has been an increased emphasis on the evaluation of federally funded programs to improve the effectiveness and public accountability of the federal programs (GAO 2004). Despite being one of the largest and longest (in operation for more than 40 years and implemented in all 50 states and six US territories) nutrition education programs in the US (GAO 2004), its evaluation has been sparse and its effectiveness largely unknown. EFENP is designed to serve the limited resource audiences, both adults and youths, by helping them acquire “the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and improvement of the overall family diet and nutritional well-being” (USDA 2011). According to the USDA‟s annual impact report of EFNEP, the participants have shown improvements in different domains of nutrition behavior (USDA 2011). Effectiveness of EFNEP for adults is substantiated by several studies that have appeared in the peer reviewed journal (Arnold and Sobal 2000; Rajgopal et al. 2002; Dollahite et al. 2008). Although youths comprise a large portion, more than 75% of EFNEP beneficiaries, evaluations of youth EFNEP have largely remain undocumented. Townsend and colleagues (2006) are only scholars to study the effectiveness of youth EFNEP. By using USDA‟s selected youth impact indicators as outcome measures, they found that the participants who received the lessons had higher post-test scores than the counterparts. Routine evaluation of the Youth EFNEP by USDA is primarily based on the number of youths who improve in any of the following four impact indicators: (i) increase in variety of foods they eat; (ii) increase in nutritional knowledge; (iii) increase in ability to select low-cost, nutritious food; and (iv) improvement in food preparation and safety practices. Part of the reason for the scantiness in evaluation studies on youth EFNEP is due to the lack of valid and reliable assessment tools. No federal guideline mandates the use of any specific instrument or even curricula for youth EFNEP. For evaluation, the state program often creates their own survey instruments. This results in the lack of consistency and standardization across EFNEP program evaluation. Recently, a concerted effort has been made to develop a standardized instrument to measure the outcomes of the youth EFNEP. This effort was a part of the larger project on the cost effectiveness of youth EFNEP and the process was closely monitored and guided by the “advisory board” that consists of nationally recognized faculty with expertise in nutrition, EFNEP, economics, item response theory, and program evaluation. We utilize the data collected using this instrument to evaluate effectiveness of the youth EFNEP in Virginia. In particular, we attempt to measure the outcomes of the youth EFNEP program and to explore the factors that contribute to the effectiveness of the program. We take an item theoretic approach and applied a Rasch measurement model 1 to measure program outcomes. Application of the Rasch measurement model is novel in the current context, and is an improvement over the outcome measure in practice by USDA. Using the Rasch outcome scores as a dependent variable, we

Research paper thumbnail of Additional file 5 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 5. Modelled cost of illness (2015 USD) estimates by country, excluding cost assoc... more Additional file 5. Modelled cost of illness (2015 USD) estimates by country, excluding cost associated with oral rehydrated solution (ORS).

Research paper thumbnail of Additional file 3 of Cost of illness for childhood diarrhea in low- and middle-income countries: a systematic review of evidence and modelled estimates

Additional file 3. Modelled cost of illness (2015 USD) estimates by country, using WHO-CHOICE ser... more Additional file 3. Modelled cost of illness (2015 USD) estimates by country, using WHO-CHOICE service delivery unit cost estimates.

Research paper thumbnail of Returns to Scale and the Effectiveness of Money Spent on the Expanded Food and Nutrition Education Program

In operation for more than 40 years and now in all 50 states and 6 territories, the Expanded Food... more In operation for more than 40 years and now in all 50 states and 6 territories, the Expanded Food and Nutrition Education Program has become a cornerstone in US nutrition education. The aim of the program is to assist limited resource audiences to acquire the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and improvement of the overall family diet and nutritional well-being. However, very little is known about the effectiveness of this program, especially at the national level. The purpose of this research is to determine the effectiveness of money spent on the Expanded Food and Nutrition Education Program in satisfying its stated goals for adult participants. Data from all states and territories participating in the program for the years 2000-2006 are utilized in a non-linear seemingly unrelated regression framework to estimate returns to scale and related cost measures. Controlling for par...

Research paper thumbnail of The Cost Effectiveness of Educating Limited Resource Youths on Food and Nutrition

Agricultural and Applied Economics Association, 2013

A framework for estimating cost effectiveness of the youth Expanded Food and Nutrition Education ... more A framework for estimating cost effectiveness of the youth Expanded Food and Nutrition Education Program (EFNEP), one of the largest nutrition education programs in the US, is developed. Using costs and effects data from 15 program counties in Virginia for the school year 2011/2012, the cost effectiveness ratio (CER) of the Healthy Weights for Healthy Kids (HWHK) program was estimated. Improvements in nutrition related behavior, and improvements in nutrition related self-efficacy, from pretest to posttest, were considered as two indicators of program effects. Direct costs associated with the provision of the HWHK program were considered program costs. The total cost of the program was estimated to be 134,333foroneyear.Among1,864participants,1,786improvedinbehaviorindicatorsand1,782improvedinself−efficacyindicators.TheestimatedCERisabout134,333 for one year. Among 1,864 participants, 1,786 improved in behavior indicators and 1,782 improved in self-efficacy indicators. The estimated CER is about 134,333foroneyear.Among1,864participants,1,786improvedinbehaviorindicatorsand1,782improvedinself−efficacyindicators.TheestimatedCERisabout75 per improvement for each outcome indicator. Cross county comparisons reveal a wide variation in CER estimates across counties. The results from this study provide the first piece of information on the CER for youth EFNEP which quantify the effects of investment on youth EFNEP program in Virginia in achieving the stated program objectives.

Research paper thumbnail of Expenditure and Health System Productivity by Disease and Injury in the US from 1996 to 2010

Research paper thumbnail of Evaluating the potential economic and health impact of rotavirus vaccination in 63 middle-income countries not eligible for Gavi funding: a modelling study

The Lancet Global Health, 2021

Background Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccin... more Background Middle-income countries (MICs) that are not eligible for funding from Gavi, the Vaccine Alliance, have been slow to adopt rotavirus vaccines. Few studies have evaluated the cost-effectiveness and benefit-risk of rotavirus vaccination in these settings. We aimed to assess the potential economic and health impact of rotavirus vaccination in 63 MICs not eligible for funding from Gavi. Methods In this modelling study, we estimated the cost-effectiveness and benefit-risk of rotavirus vaccination in 63 MICs not eligible to Gavi funding. We used an Excel-based proportionate outcomes model with a finely disaggregated age structure to estimate the number of rotavirus gastroenteritis cases, clinic visits, hospitalisations, and deaths averted by vaccination in children younger than 5 years over a 10-year period. We calculated costeffectiveness ratios (costs per disability-adjusted life-years averted compared with no vaccination) and benefit-risk ratios (number of hospitalisations due to rotavirus gastroenteritis averted per excess hospitalisations due to intussusception). We evaluated three alternative vaccines available globally (Rotarix, Rotavac, and Rotasiil) and used information from vaccine manufacturers regarding anticipated vaccine prices. We ran deterministic and probabilistic uncertainty analyses. Findings Over the period 2020-29, rotavirus vaccines could avert 77 million (95% uncertainty interval [UI] 51-103) cases of rotavirus gastroenteritis and 21 million (12-36) clinic visits, 3 million (1•4-5•6) hospitalisations, and 37 900 (25 900-55 900) deaths due to rotavirus gastroenteritis in 63 MICs not eligible for Gavi support. From a government perspective, rotavirus vaccination would be cost-effective in 48 (77%) of 62 MICs considered. The benefit-risk ratio for hospitalisations prevented versus those potentially caused by vaccination exceeded 250:1 in all countries. Interpretation In most MICs not eligible for Gavi funding, rotavirus vaccination has high probability to be costeffective with a favourable benefit-risk profile. Policy makers should consider this new evidence when making or revisiting decisions on the use of rotavirus vaccines in their respective countries. Funding Bill & Melinda Gates Foundation.

Research paper thumbnail of Costs of continuing RTS,S/ASO1E malaria vaccination in the three malaria vaccine pilot implementation countries

PLOS ONE, 2021

Background The RTS,S/ASO1E malaria vaccine is being piloted in three countries—Ghana, Kenya, and ... more Background The RTS,S/ASO1E malaria vaccine is being piloted in three countries—Ghana, Kenya, and Malawi—as part of a coordinated evaluation led by the World Health Organization, with support from global partners. This study estimates the costs of continuing malaria vaccination upon completion of the pilot evaluation to inform decision-making and planning around potential further use of the vaccine in pilot areas. Methods We used an activity-based costing approach to estimate the incremental costs of continuing to deliver four doses of RTS,S/ASO1E through the existing Expanded Program on Immunization platform, from each government’s perspective. The RTS,S/ASO1E pilot introduction plans were reviewed and adapted to identify activities for costing. Key informant interviews with representatives from Ministries of Health (MOH) were conducted to inform the activities, resource requirements, and assumptions that, in turn, inform the analysis. Both financial and economic costs per dose, cos...