Dr. Alex Adjagba, MD . MSc Health Economics & Policy Officer

1. Estimating the economic burden of malaria in Sub-Saharan Africa : a first step towards the cost-effectiveness of malaria vaccine • Dr. Alex Adjagba, MD. MSc • Health Economics & Policy Officer • The PATH Malaria Vaccine Initiative, • Ferney-Voltaire, France • 2nd Conference of the AFHEA • Saly, March 16th, 2011 • A multi country study

2. Outline • Introduction & background • Objectives of MVI economic project • The cost of illness multi-country study • Methodology • Analyses and types of outputs • Next steps • Conclusion • Acknowledgments

3. Introduction PATH MVI mission • To accelerate the development of malaria vaccines and ensure their availability and accessibility in the developing world Health economics project • Aim to support the world’s clinically most advanced vaccine candidate, the GSK’s RTS,S • Involves working with researchers at international (JHU and Swiss TPHI) and country level

4. Background on RTS,S • Ongoing phase 3 clinical trials in 7 countries in sub-Saharan Africa (Burkina Faso, Gabon, Ghana, Kenya, Mozambique, Malawi and Tanzania) • Over 15,000 infants and children enrolled • Initial data from the trial will be available this fall, with more to follow over the next few years • WHO recommendation not expected before 2015.

5. Answering efficiency & affordability • Is RTS,S added to current control measures • A cost effective package? (CEA) • Affordable for countries in the context of their current health budgets? (budget impact analysis) • Will be used to support decisions at: • WHO requires to make a recommendation on vaccine use • Funding partners to prioritize countries’ application • Countries to assess their specific environment

6. Why a multi-country cost of illness study? • Complement health burden data • Estimate the economic impact of malaria in terms of costs to households and health systems in sub-Saharan Africa • Identify who bears the costs of illness by socio-economics groups • Capture the diversity in economic burden • Due to differences in epidemiology, seasonality, health systems and malaria programs performances, economic development • Comparability of country data

7. Methodology 1: sample selection • Exclusion criteria • All patients enrolled in the RTS,S clinical trials • Inclusion criteria • Patients under 5 years old with a clinical diagnosis of malaria with subsequent laboratory confirmation, where possible and their parents (or accompanying responsible persons)

8. Methodology 2: study components • Health facilities • Exit interviews of outpatient (OPD) and inpatient (IPD) departments’ attendants • costs of consultation, • treatment & tests costs , • transportation costs from home to health facility, • household socio-economic situation • All costs spent before arriving to the study health center • Records review: both retrospectively and prospectively in OPD & IPD (seasonality aspect) • diagnosis, disease history, confirmation tests, • treatment and drug costs • length of stay, health staff who treated the case • Outcome (death, sequelae…)

9. Methodology 3: study components (2) • Health providers’ interviews • What they should do: national guidelines • What they say they do: treatment given • What they actually do: patient card/record • Households’ survey • 500 households with children under 5 years old • Costs ofmalaria treatment in the last 2 weeks before study (direct & indirect – including lost wages, origin of funds, payers) • Prevention costs • Personal assets and household’s amenities

10. Countries involved & Current status

11. Perspectives of analyses and outputs • Costs to household (simple or severe malaria) • direct medical costs (medications, diagnostics…) • direct non-medical costs (transportation, accommodation..) • indirect costs (loss of productivity due to care seeking) • socio-economic distribution of malaria burden • factors associated to each level of out-of-pocket expenses Sub-analyses by confirmed vs. non confirmed cases; insured patients vs. uninsured; public vs. private • Costs to health systems • Treatments and lab tests costs incurred by health facility • Staff costs estimated by malaria case (salaries, time…)

12. Next steps • Roll-out the study in remaining countries • Disseminate results • Use data collected in the STPHI transmission-based model to produce cost-effectiveness estimates of RTS,S • Release those estimates paced with release of RTS,S vaccine phase 3 efficacy initial results • Update the estimates regularly to reflect further releases of vaccine efficacy data • Data collected made available in a public database

13. Conclusion • MVI candidate vaccine against malaria will be used in the context of existing control measures • MVI intends to release cost-effectiveness estimates of the vaccine and other economic estimates to support policy decision • MVI and its partners designed this multi-country study to capture as much as possible malaria economic burden, as a critical input in the estimation of CEA

14. Acknowledgments • To colleagues involved at PATH Malaria Vaccine Initiative • To all partners at JHU, STPHI, and countries’ research institutions • In particular to Drs Chris Atim and Damian Walker