{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T12:31:46Z","timestamp":1794486706041,"version":"4.9.1"},"reference-count":44,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UNICEF and Al Waleed Philanthropies","award":["43317323"],"award-info":[{"award-number":["43317323"]}]},{"name":"Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation","award":["OPP1157270\/INV-009125"],"award-info":[{"award-number":["OPP1157270\/INV-009125"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2023,10,1]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Microarray patches (MAPs) are a promising technology being developed to reduce barriers to vaccine delivery based on needles and syringes (N&amp;S). 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 cost-effectiveness of introducing measles-rubella MAPs (MR-MAPs) in 70 low-income and middle-income countries (LMICs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used an age-structured dynamic model of measles transmission and vaccination to project measles cases, deaths and disability-adjusted life-years during 2030\u20132040. Compared with the baseline scenarios with continuing current N&amp;S-based practice, we evaluated the introduction of MR-MAPs under different 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>MR-MAP introduction could prevent 27%\u201337% of measles burden between 2030 and 2040 in 70 LMICs, compared with the N&amp;S-only immunisation strategy. The largest health impact could be achieved under lower coverage projection and accelerated introduction strategy, with 39\u2009million measles cases averted. Measles treatment cost is a key driver of the net cost of introduction. In countries with a relatively higher income, introducing MR-MAPs could be a cost-saving intervention due to reduced treatment costs. Compared with country-specific health opportunity costs, introducing MR-MAPs would be cost-effective in 16%\u201381% of LMICs, depending on the MR-MAPs procurement prices and vaccine coverage projections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Introducing MR-MAPs in LMICs can be a cost-effective strategy to revitalise measles immunisation programmes with stagnant uptake and reach undervaccinated 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2023-012204","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T12:05:24Z","timestamp":1699617924000},"page":"e012204","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Impact and cost-effectiveness of measles vaccination through microarray patches in 70 low-income and middle-income countries: mathematical modelling and early-stage economic evaluation"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-7347","authenticated-orcid":false,"given":"Han","family":"Fu","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0563-1576","authenticated-orcid":false,"given":"Kaja","family":"Abbas","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Public Health Foundation of India, New Delhi, India"},{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0146-1127","authenticated-orcid":false,"given":"Stefano","family":"Malvolti","sequence":"additional","affiliation":[{"name":"MMGH Consulting GmbH, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gregory","sequence":"additional","affiliation":[{"name":"Immunization Unit, Programme Division, UNICEF, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Ko","sequence":"additional","affiliation":[{"name":"MMGH Consulting GmbH, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre","family":"Amorij","sequence":"additional","affiliation":[{"name":"Supply Division, Vaccine Centre, UNICEF, Kobenhavn, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jit","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"2025073014561846000_8.11.e012204.1","first-page":"59","article-title":"Expanded programme on immunization","volume":"41","author":"Keja","year":"1988","journal-title":"World Health Stat Q"},{"key":"2025073014561846000_8.11.e012204.2","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0140-6736(20)32657-X","article-title":"Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a Modelling study","volume":"397","author":"Li","year":"2021","journal-title":"Lancet"},{"key":"2025073014561846000_8.11.e012204.3","first-page":"205","article-title":"Measles vaccines: WHO position paper - April 2017","volume":"92","year":"2017","journal-title":"Weekly Epidemiological Record"},{"key":"2025073014561846000_8.11.e012204.4","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S0140-6736(21)01337-4","article-title":"Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study","volume":"398","author":"Causey","year":"2021","journal-title":"Lancet"},{"key":"2025073014561846000_8.11.e012204.5","unstructured":"World Health Organization . Immunization data portal [Dataset]. 2021. Available: https:\/\/immunizationdata.who.int\/listing.html [Accessed 20 Jul 2021]."},{"key":"2025073014561846000_8.11.e012204.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003024","article-title":"Safety, tolerability, and immunogenicity of influenza vaccination with a high-density microarray patch: results from a randomized, controlled phase I clinical trial","volume":"17","author":"Forster","year":"2020","journal-title":"PLoS Med"},{"key":"2025073014561846000_8.11.e012204.7","unstructured":"The Vaccine Innovation Prioritisation Strategy . VIPS phase 2 techinical NOTE: microarray patches [online]. 2020. Available: https:\/\/www.gavi.org\/sites\/default\/files\/about\/market-shaping\/Phase-II\/8_VIPS%20Phase%20II%20Technical%20Note%20Microarray%20Patches%20%28MAPs%29.pdf"},{"key":"2025073014561846000_8.11.e012204.8","unstructured":"Gavi, the Vaccine Alliance . Vaccine Microarray patches (maps): public summary of the VIPS alliance action plan. 2021."},{"key":"2025073014561846000_8.11.e012204.9","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.supp.2020.35.1.19753","article-title":"Measles and rubella microarray array patches to increase vaccination coverage and achieve measles and rubella elimination in Africa","volume":"35","author":"Richardson","year":"2020","journal-title":"Pan Afr Med J"},{"key":"2025073014561846000_8.11.e012204.10","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.809675","article-title":"Accelerating the development of measles and rubella microarray patches to eliminate measles and rubella: recent progress, remaining challenges","volume":"10","author":"Hasso-Agopsowicz","year":"2022","journal-title":"Front Public Health"},{"key":"2025073014561846000_8.11.e012204.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.03.035"},{"key":"2025073014561846000_8.11.e012204.12","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiy139"},{"key":"2025073014561846000_8.11.e012204.13","unstructured":"Measles and rubella vaccine microneedle patch phase 1-2 age de-escalation trial. 2020. Available: https:\/\/ClinicalTrials.gov\/show\/NCT04394689 [Accessed 1 May 2022]."},{"key":"2025073014561846000_8.11.e012204.14","unstructured":"Vaxxas Pty Ltd . First-in-human study to investigate the skin tolerability of micro-projection array patches coated with live attenuated measles and rubella vaccine in healthy adult volunteers [online]. 2021. Available: https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?ACTRN=12621000820808"},{"key":"2025073014561846000_8.11.e012204.15","unstructured":"Goodbye syringe? measles and rubella patch demonstrates its worth in Gambia vaccine trial. Available: https:\/\/www.gavi.org\/vaccineswork\/goodbye-syringe-measles-and-rubella-patch-demonstrates-its-worth-gambia-vaccine [Accessed 20 Sep 2023]."},{"key":"2025073014561846000_8.11.e012204.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.11.017"},{"key":"2025073014561846000_8.11.e012204.17","unstructured":"World Health Organization, United Nations Children\u2019s Fund . Measles-rubella Microarray patch (MR\u2013MAP) target product profile [online]. 2019. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240000209 [Accessed 20 May 2020]."},{"key":"2025073014561846000_8.11.e012204.18","doi-asserted-by":"crossref","unstructured":"Hutubessy R , Lauer JA , Giersing B , et al . The full value of vaccine assessments (FVVA): a framework for assessing and communicating the value of vaccines for investment and introduction decision-making. BMC Med 2023;21. doi:10.1186\/s12916-023-02929-0","DOI":"10.1186\/s12916-023-02929-0"},{"key":"2025073014561846000_8.11.e012204.19","unstructured":"UNICEF Office of Innovation . Vaccine microarray patches (Vmaps) [online]. Available: https:\/\/www.unicef.org\/innovation\/vaccine-microarray-patches-vmaps [Accessed 8 Aug 2023]."},{"key":"2025073014561846000_8.11.e012204.20","unstructured":"The World Bank . World Bank country and lending groups, 1987-2020 [online]. Available: http:\/\/databank.worldbank.org\/data\/download\/site-content\/CLASS.xlsx [Accessed 31 Aug 2021]."},{"key":"2025073014561846000_8.11.e012204.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-021-02157-4","article-title":"Effect of evidence updates on key determinants of measles vaccination impact: a Dynamice Modelling study in ten high-burden countries","volume":"19","author":"Fu","year":"2021","journal-title":"BMC Med"},{"key":"2025073014561846000_8.11.e012204.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1009098","article-title":"Projecting contact matrices in 177 geographical regions: an update and comparison with empirical data for the COVID-19 era","volume":"17","author":"Prem","year":"2021","journal-title":"PLoS Comput Biol"},{"key":"2025073014561846000_8.11.e012204.23","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30307-9"},{"key":"2025073014561846000_8.11.e012204.24","doi-asserted-by":"publisher","DOI":"10.1016\/s2214-109x(18)30537-0"},{"key":"2025073014561846000_8.11.e012204.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.02.072"},{"key":"2025073014561846000_8.11.e012204.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.10.090"},{"key":"2025073014561846000_8.11.e012204.27","doi-asserted-by":"crossref","first-page":"i48","DOI":"10.1093\/ije\/dyq021","article-title":"Effectiveness of measles vaccination and vitamin A treatment","volume":"39 Suppl 1","author":"Sudfeld","year":"2010","journal-title":"Int J Epidemiol"},{"key":"2025073014561846000_8.11.e012204.28","unstructured":"World Health Organization . Global market study: measles-containing Vacclines (MCV) [online]. 2020. Available: https:\/\/www.who.int\/immunization\/programmes_systems\/procurement\/mi4a\/platform\/module2\/Measles_Containing_Vaccines_Market_Study_Public_Summary_July2020.pdf?ua=1"},{"key":"2025073014561846000_8.11.e012204.29","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.1037157","article-title":"Estimating the future global dose demand for measles-rubella microarray patches","volume":"10","author":"Ko","year":"2022","journal-title":"Front Public Health"},{"key":"2025073014561846000_8.11.e012204.30","unstructured":"The World Bank . GDP deflator (base year varies by country). Available: https:\/\/data.worldbank.org\/indicator\/NY.GDP.DEFL.ZS [Accessed 30 Nov 2021]."},{"key":"2025073014561846000_8.11.e012204.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.03.021"},{"key":"2025073014561846000_8.11.e012204.32","unstructured":"World Health Organization . Mi4A vaccine purchase database. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/mi4a\/mi4a_public_database.xlsx?sfvrsn=1adc791a_11 [Accessed 6 Dec 2021]."},{"key":"2025073014561846000_8.11.e012204.33","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1093\/infdis\/jir096","article-title":"Global eradication of measles: an epidemiologic and economic evaluation","volume":"204 Suppl 1","author":"Levin","year":"2011","journal-title":"J Infect Dis"},{"key":"2025073014561846000_8.11.e012204.34","unstructured":"World Health Organization . WHO guide for standardization of economic evaluations of immunization programmes. 2019. Available: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/329389\/WHO-IVB-19.10-eng.pdf?ua=1 [Accessed 7 Apr 2021]."},{"key":"2025073014561846000_8.11.e012204.35","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.164418"},{"key":"2025073014561846000_8.11.e012204.36","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czab104"},{"key":"2025073014561846000_8.11.e012204.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2019.12.002"},{"key":"2025073014561846000_8.11.e012204.38","doi-asserted-by":"publisher","DOI":"10.1007\/s40268-016-0144-x"},{"key":"2025073014561846000_8.11.e012204.39","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-03043-4"},{"key":"2025073014561846000_8.11.e012204.40","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0167160","article-title":"The effect of contact investigations and public health interventions in the control and prevention of measles transmission: a simulation study","volume":"11","author":"Enanoria","year":"2016","journal-title":"PLoS One"},{"key":"2025073014561846000_8.11.e012204.41","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz127"},{"key":"2025073014561846000_8.11.e012204.42","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-017-0606-1"},{"key":"2025073014561846000_8.11.e012204.43","unstructured":"World Health Organization . WHO evidence considerations for vaccine policy development (ECVP): generic framework for vaccines\/monoclonal antibodies in development. 2022. Available: https:\/\/www.who.int\/publications\/m\/item\/who-evidence-considerations-for-vaccine-policy-development-(ecvp) [Accessed 16 Oct 2022]."},{"key":"2025073014561846000_8.11.e012204.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.10.062"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2023-012204","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T21:56:26Z","timestamp":1753912586000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2023-012204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,10]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjgh-2023-012204"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2023-012204","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}