Cost-effective threshold price for alternative infant and neonatal rotavirus vaccines: a dual-country evaluation

Suboptimal rotavirus vaccine effectiveness in low- and middle-income countries (LMICs) highlights the need for next-generation vaccines, such as the neonatal RV3-BB vaccine. However, there is uncertainty in the level and duration of protection and future price of vaccines in development. We aim to identify the conditions under which switching to RV3-BB is optimal in Malawi and Ghana. Validated, country-calibrated transmission models were used to conduct a full incremental cost-effectiveness analysis comparing all relevant vaccination strategies. In Malawi, RV3-BB, 3-dose Rotarix, 3-dose Rotavac, vaccine suspension, and the current 2-dose Rotarix program were evaluated. In Ghana, RV3-BB and vaccine suspension were compared with the current 3-dose Rotavac program. Over 2025–2034, introducing RV3-BB resulted in the largest rotavirus-related burden reduction compared with the current country-specific programs. From the governmental perspective, at $0.70/dose, RV3-BB becomes the preferred strategy at willingness-to-pay (WTP) >$80 per disability-adjusted life-year (DALY) averted in Malawi ( ~ 13% of gross domestic product per capita (GDP/capita)) and >$216 in Ghana ( ~ 7% of GDP/capita). In Malawi, the choice between Rotavac and RV3-BB depends on price, protective level and duration of RV3-BB and the WTP threshold, whereas in Ghana, RV3-BB price and protection parameters are less influential at WTP thresholds above 0.25-times GDP/capita.