Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low- and middle-income countries: a modelling study

Background Microarray patches are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes. To address the evidence gap on the public health value of applying this potential technology to immunisation programmes, we evaluated the health impact on measles burden and resulting cost-effectiveness of introducing measles-rubella microarray patches (MR-MAPs) in 70 low- and middle-income countries (LMICs). Methods We used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths, and disability-adjusted life years during 2030⍰2040. Compared to the baseline scenarios with continuing current needle-based immunisation practice, we evaluated the introduction of MR-MAPs under different assumptions on measles vaccine coverage projections and MR-MAP introduction strategies. Costs were calculated based on the ingredients approach, including direct cost of measles treatment, vaccine procurement, and vaccine delivery. Model-based burden and cost estimates were derived for individual countries and country income groups. We compared the incremental cost-effectiveness ratios of introducing MR-MAPs to health opportunity costs. Results MR-MAPs introduction could prevent 27%⍰37% of measles burden between 2030⍰2040 in 70 LMICs. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39 million measles cases averted. Cost of measles treatment is a key driver of the net cost of introduction. In LMICs with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduction in measles treatment costs. Compared to country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16⍰81% of LMICs, depending on the MR-MAPs procurement price and vaccine coverage projections. Conclusions Introducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach under-vaccinated children. Sustainable introduction and uptake of MR-MAPs has the potential to improve vaccine equity within and between countries and accelerate progress towards measles elimination. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work is part of the initial Full Vaccine Value Assessment (iFVVA) for MR-MAPs, which is funded by UNICEF and Al Waleed Philanthropies (grant number 43317323). HF, KA, and MJ from the London School of Hygiene & Tropical Medicine receive funding support from the Bill and Melinda Gates Foundation via the Vaccine Impact Modelling Consortium (grant number INV-009125). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data and codes produced in the present are available upon reasonable request to the authors and will be made public in a GitHub repository once the manuscript is accepted for journal publication.