Volume 14, Issue 8, Pages (December 2011)

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Volume 14, Issue 8, Pages 1028-1038 (December 2011) Cost-Effectiveness of the Introduction of a Pre-Erythrocytic Malaria Vaccine into the Expanded Program on Immunization in Sub-Saharan Africa: Analysis of Uncertainties Using a Stochastic Individual-Based Simulation Model of Plasmodium falciparum Malaria  Nicolas Maire, PhD, Samuel D. Shillcutt, MS, Damian G. Walker, PhD, Fabrizio Tediosi, PhD, Thomas A. Smith, PhD  Value in Health  Volume 14, Issue 8, Pages 1028-1038 (December 2011) DOI: 10.1016/j.jval.2011.06.004 Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 1 Distributions of the entomological inoculation rate (EIR). A, Estimated distribution of exposure for 2007 across Sub-Saharan Africa (SSA). B. Adjusted distribution in which all EIRs <1.05 infectious bites per annum (ibpa) are shifted into a single category centered at 1.05 ibpa (hatched column). The areas of the solid columns correspond to the proportions of the population of SSA assigned to each EIR category. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 2 Cost-effectiveness planes. Each circle corresponds to one parameterization. The four panels correspond to the lowest of the 15 entomological inoculation rate (EIR) values analyzed (for which the data were obtained by interpolation) (A); the lowest EIR simulated (B); an intermediate EIR (C), and a high EIR (D). The diagonal lines correspond to ceiling ratios of international dolloars (I$) 207 per disability-adjusted life-year (DALY) averted (less steep lines) and I$2008 per DALY averted (steeper lines). Net costs and DALYs averted are computed for a simulated population of 100,000 people with discounting. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 3 Incremental cost-effectiveness ratio (ICER) by transmission intensity. The envelope encloses the interquartile range for 1000 simulations. Values for entomological inoculation rate (EIR) <2.1 infectious bites per annum (ibpa) (to the left of the vertical dashed line) are based on interpolation between EIR 0 and EIR 2.1 ibpa. Undiscounted costs (A); discounted costs (B). Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 4 Probability that the vaccination program is cost-effective. Each probability is calculated as a proportion of 1000 simulations where the incremental cost-effectiveness ratio (ICER) is less than the ceiling ratio. When the number of DALYs averted is negative, the ICER is assigned a value higher than the ceiling ratio to avoid classifying these simulations as cost-effective. The shaded boxes indicate the ceiling ratios in international dollars per disability-adjusted life-year averted. EIR, entomological inoculation rate; ibpa, infectious bites per annum. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 5 Acceptability curves. Each probability is calculated as a proportion of 1000 simulations where the incremental cost-effectiveness ratio (ICER) was less than the ceiling ratio. When the number of disability-adjusted life-years (DALYs) averted is negative, the ICER is assigned a value higher than the ceiling ratio to avoid classifying these simulations as cost-effective. The shaded boxes indicate the ceiling ratios in international dollars (I$) per DALY averted. The dashed line corresponds to entomological inoculation rate (EIR) distribution A, and the solid line corresponds to EIR distribution B. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 6 Tornado diagram. Contributions to uncertainty with entomological inoculation rate distribution A. The horizontal bars correspond to the interval between the incremental cost-effectiveness ratios (ICERs) predicted from the regression at the 2.5 and 97.5 percentiles of the sampled distribution of the parameters, with the other variables held at their central values. Only the 14 parameters with the greatest contributions to uncertainty are included. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions

Fig. 7 Expected value of perfect information (EVPI). EVPI capita of the total population. The shaded boxes indicate the ceiling ratios in international dollars per disability-adjusted life-year (I$/DALY) averted. The dashed line corresponds to entomological inoculation rate distribution A, and the solid line corresponds to entomological inoculation rate distribution B. Value in Health 2011 14, 1028-1038DOI: (10.1016/j.jval.2011.06.004) Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Terms and Conditions