COST-EFFECTIVENESS AND UNCERTAINTY ANALYSIS OF EBOLA VACCINATION STRATEGIES IN CHILDREN AND ADOLESCENTS
Author(s)
Marianna Zarro, MD, Katsiaryna Bashlakova, MD, PhD, Annalisa Rosso, MD, PhD, Corrado De Vito, MD, PhD.
Sapienza University of Rome, Rome, Italy.
Sapienza University of Rome, Rome, Italy.
OBJECTIVES: Ebola virus disease remains a severe public health threat, particularly affecting pediatric populations with high mortality. Although Ad26.ZEBOV/MVA-BN-Filo (Ad26/MVA) and rVSV-ΔG-ZEBOV (rVSV) vaccines are approved by the European Medicines Agency, no direct comparative economic evaluation has been performed in children <19. This study aimed to compare the cost-effectiveness of these two vaccination strategies.
METHODS: A decision tree model compared Ad26/MVA, rVSV, and no vaccination from a healthcare system perspective. Probabilities of infection, survival, and death were derived from outbreak data (2025, Democratic Republic of Congo) and clinical trial evidence. Costs included acute clinical management, death and vaccine acquisition, updated to 2024 US$. Health outcomes were expressed in disability-adjusted life years (DALYs). Incremental cost-effectiveness ratios (ICERs) were calculated vs no vaccination. One-way sensitivity analysis assessed vaccine price uncertainty, while probabilistic sensitivity analysis explored parameter uncertainty. Cost-effectiveness acceptability curves were generated across willingness-to-pay thresholds.
RESULTS: In the base case, rVSV generated 0.470 DALYs averted at an ICER of 203.53 $/DALY, while Ad26/MVA generated 0.419 DALYs averted at 280.14 $/DALY. Deterministic sensitivity analysis showed that Ad26/MVA-based ICERs were highly sensitive to vaccine price, becoming dominant under donor-funded scenarios. In probabilistic analysis, Ad26/MVA had a mean ICER of 101.12 $/DALY (95% CI: 5.59-331.53), while rVSV had a mean ICER of 231.97 $/DALY (95% CI: 74.02-545.43). At a willingness-to-pay threshold of 500 $/DALY, the probability of cost-effectiveness was 0.993 for Ad26/MVA and 0.963 for rVSV.
CONCLUSIONS: Both Ebola vaccines are highly cost-effective in pediatric populations under outbreak conditions. However, Ad26/MVA demonstrates superior economic efficiency and greater robustness under uncertainty, particularly in donor-funded scenarios.
METHODS: A decision tree model compared Ad26/MVA, rVSV, and no vaccination from a healthcare system perspective. Probabilities of infection, survival, and death were derived from outbreak data (2025, Democratic Republic of Congo) and clinical trial evidence. Costs included acute clinical management, death and vaccine acquisition, updated to 2024 US$. Health outcomes were expressed in disability-adjusted life years (DALYs). Incremental cost-effectiveness ratios (ICERs) were calculated vs no vaccination. One-way sensitivity analysis assessed vaccine price uncertainty, while probabilistic sensitivity analysis explored parameter uncertainty. Cost-effectiveness acceptability curves were generated across willingness-to-pay thresholds.
RESULTS: In the base case, rVSV generated 0.470 DALYs averted at an ICER of 203.53 $/DALY, while Ad26/MVA generated 0.419 DALYs averted at 280.14 $/DALY. Deterministic sensitivity analysis showed that Ad26/MVA-based ICERs were highly sensitive to vaccine price, becoming dominant under donor-funded scenarios. In probabilistic analysis, Ad26/MVA had a mean ICER of 101.12 $/DALY (95% CI: 5.59-331.53), while rVSV had a mean ICER of 231.97 $/DALY (95% CI: 74.02-545.43). At a willingness-to-pay threshold of 500 $/DALY, the probability of cost-effectiveness was 0.993 for Ad26/MVA and 0.963 for rVSV.
CONCLUSIONS: Both Ebola vaccines are highly cost-effective in pediatric populations under outbreak conditions. However, Ad26/MVA demonstrates superior economic efficiency and greater robustness under uncertainty, particularly in donor-funded scenarios.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE447
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Disease
Vaccines