{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:11:30Z","timestamp":1779117090259,"version":"3.51.4"},"posted":{"date-parts":[[2026,5,15]]},"group-title":"Health Economics","reference-count":57,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>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 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, where the current immunization programs use 2-dose Rotarix and 3-dose Rotavac schedules, respectively. A full incremental cost- effectiveness analysis was performed using a validated transmission model calibrated to country-specific rotavirus data. Over 2025\u20132034, introducing RV3-BB resulted in the largest rotavirus-related burden reduction compared with the current country-specific programs. At moderate willingness-to-pay (\u223c0.5-time Gross Domestic Product per capita), RV3-BB was preferred over Rotavac if price per dose was &lt;$1.2 in Malawi and &lt;$2.5 in Ghana, and\/or if the average duration of protection exceeded 40 weeks in Malawi. The RV3-BB vaccine is likely to be cost-effective in Malawi and Ghana, as well as other LMICs, based on expected pricing and duration of protection.<\/jats:p>","DOI":"10.64898\/2026.05.12.26353029","type":"posted-content","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T22:40:17Z","timestamp":1778884817000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effective Threshold Price for Alternative Infant and Neonatal Rotavirus Vaccines: A Dual-Country Evaluation"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1918-1791","authenticated-orcid":false,"given":"Xiao","family":"Li","sequence":"first","affiliation":[{"name":"Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium"},{"name":"Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4078-8755","authenticated-orcid":false,"given":"Ernest O.","family":"Asare","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, United States"},{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2707-3547","authenticated-orcid":false,"given":"Jiye","family":"Kwon","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, United States"},{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5564-0630","authenticated-orcid":false,"given":"Catherine G. C.","family":"Wenger","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6078-9953","authenticated-orcid":false,"given":"George E.","family":"Armah","sequence":"additional","affiliation":[{"name":"Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, Department of Disease Control and Epidemiology, School of Public Health, University of Ghana, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5449-4988","authenticated-orcid":false,"given":"Nigel A.","family":"Cunliffe","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, Merseyside, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3376-8529","authenticated-orcid":false,"given":"Khuzwayo C.","family":"Jere","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, Merseyside, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5720-5291","authenticated-orcid":false,"given":"Joke","family":"Bilcke","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5034-3595","authenticated-orcid":false,"given":"Philippe","family":"Beutels","sequence":"additional","affiliation":[{"name":"Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-2289","authenticated-orcid":false,"given":"Virginia E.","family":"Pitzer","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, United States"},{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026051808001392000_2026.05.12.26353029v1.1","unstructured":"Initiative for Vaccine Research (IVR). WHO guide for standardization of economic evaluations of immunization programmes., (2008)."},{"key":"2026051808001392000_2026.05.12.26353029v1.2","unstructured":"Unicef. Under-five mortality, <https:\/\/data.unicef.org\/topic\/child-survival\/under-five-mortality\/#:~:text=Globally%2C%20infectious%20diseases%2C%20including%20pneumonia,birth%20and%20intrapartum%2Drelated%20complications.> (2023)."},{"key":"2026051808001392000_2026.05.12.26353029v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30262-X"},{"key":"2026051808001392000_2026.05.12.26353029v1.4","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.1960"},{"key":"2026051808001392000_2026.05.12.26353029v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30276-1"},{"key":"2026051808001392000_2026.05.12.26353029v1.6","unstructured":"International Vaccine Access Center (IVAC), J. H. B. S. o. P. H. VIEW-hub: Rotavirus vaccine: Current Vaccine Introduction Status, <https:\/\/view-hub.org\/vaccine\/rota> (2025)."},{"key":"2026051808001392000_2026.05.12.26353029v1.7","unstructured":"World Health Organization. Summary of Key Characteristics of WHO Prequalified Rotavirus Vaccines (Revised Aug 2023), <https:\/\/cdn.who.int\/media\/docs\/default-source\/immunization\/rotavirus\/who_summary-of-key-statistics-pq-rota-vaccines_nov_3_2021_revised30aug23_clean.pdf#:~:text=\u2022%20WHO%20recommends%20that%20the,weeks%20of%20age.%20A%20minimum> (2023)."},{"key":"2026051808001392000_2026.05.12.26353029v1.8","unstructured":"Unicef. Rotavirus vaccine (RV) price data, < https:\/\/www.unicef.org\/supply\/documents\/rotavirus-vaccine-rv-price-data> (2024)."},{"key":"2026051808001392000_2026.05.12.26353029v1.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904797"},{"key":"2026051808001392000_2026.05.12.26353029v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30314-0"},{"key":"2026051808001392000_2026.05.12.26353029v1.11","doi-asserted-by":"publisher","DOI":"10.1038\/s41541-024-01000-0"},{"key":"2026051808001392000_2026.05.12.26353029v1.12","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(24)00326-7"},{"key":"2026051808001392000_2026.05.12.26353029v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.06.071"},{"key":"2026051808001392000_2026.05.12.26353029v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00473-4"},{"key":"2026051808001392000_2026.05.12.26353029v1.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.08.080"},{"key":"2026051808001392000_2026.05.12.26353029v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101687"},{"key":"2026051808001392000_2026.05.12.26353029v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103122"},{"key":"2026051808001392000_2026.05.12.26353029v1.18","unstructured":"World Health Organization . (ed Vaccines and Biologicals Immunization) (World Health Organization, Geneva, Switzerland, 2019)."},{"key":"2026051808001392000_2026.05.12.26353029v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2009.06.035"},{"key":"2026051808001392000_2026.05.12.26353029v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.02.008"},{"key":"2026051808001392000_2026.05.12.26353029v1.21","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X211045070"},{"key":"2026051808001392000_2026.05.12.26353029v1.22","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X11409240"},{"key":"2026051808001392000_2026.05.12.26353029v1.23","doi-asserted-by":"crossref","unstructured":"Briggs, A. C. , K. Sculpher , M. Decision Modelling for Health Economic Evaluation. (Oxford University Press, 2006).","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"2026051808001392000_2026.05.12.26353029v1.24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001328"},{"key":"2026051808001392000_2026.05.12.26353029v1.25","unstructured":"Alliance, G. t. V. Gavi Alliance Co-financing Policy, <https:\/\/www.gavi.org\/programmes-impact\/programmatic-policies\/co-financing-policy> (2025)."},{"key":"2026051808001392000_2026.05.12.26353029v1.26","unstructured":"World Health Organization. Immunization dashboard (Vaccination coverage trendline), < https:\/\/immunizationdata.who.int\/dashboard\/regions\/african-region\/> (2024)."},{"key":"2026051808001392000_2026.05.12.26353029v1.27","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ1025"},{"key":"2026051808001392000_2026.05.12.26353029v1.28","doi-asserted-by":"publisher","DOI":"10.1086\/653578"},{"key":"2026051808001392000_2026.05.12.26353029v1.29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004341"},{"key":"2026051808001392000_2026.05.12.26353029v1.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.11.080"},{"key":"2026051808001392000_2026.05.12.26353029v1.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.01.076"},{"key":"2026051808001392000_2026.05.12.26353029v1.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2018.10.068"},{"key":"2026051808001392000_2026.05.12.26353029v1.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2019.12.014"},{"key":"2026051808001392000_2026.05.12.26353029v1.34","doi-asserted-by":"publisher","DOI":"10.12688\/gatesopenres.13201.1"},{"key":"2026051808001392000_2026.05.12.26353029v1.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2021.10.003"},{"key":"2026051808001392000_2026.05.12.26353029v1.36","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-08595-8"},{"key":"2026051808001392000_2026.05.12.26353029v1.37","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz912"},{"key":"2026051808001392000_2026.05.12.26353029v1.38","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aav6419"},{"key":"2026051808001392000_2026.05.12.26353029v1.39","doi-asserted-by":"publisher","DOI":"10.1126\/science.1172330"},{"key":"2026051808001392000_2026.05.12.26353029v1.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2020.05.057"},{"key":"2026051808001392000_2026.05.12.26353029v1.41","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.adn4176"},{"key":"2026051808001392000_2026.05.12.26353029v1.42","doi-asserted-by":"publisher","DOI":"10.1101\/2024.05.29.24308124"},{"key":"2026051808001392000_2026.05.12.26353029v1.43","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiag003"},{"key":"2026051808001392000_2026.05.12.26353029v1.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.09.120"},{"key":"2026051808001392000_2026.05.12.26353029v1.45","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004483"},{"key":"2026051808001392000_2026.05.12.26353029v1.46","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-017-4964-6"},{"key":"2026051808001392000_2026.05.12.26353029v1.47","doi-asserted-by":"publisher","DOI":"10.4314\/GMJ.V50I4.7"},{"key":"2026051808001392000_2026.05.12.26353029v1.48","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyac098"},{"key":"2026051808001392000_2026.05.12.26353029v1.49","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2024-016784"},{"key":"2026051808001392000_2026.05.12.26353029v1.50","unstructured":"Wrold Bank. Consumer price index (2010 = 100), < https:\/\/data.worldbank.org\/indicator\/FP.CPI.TOTL> (2025)."},{"key":"2026051808001392000_2026.05.12.26353029v1.51","unstructured":"World Bank. Official exchange rate (LCU per US$, period average), < https:\/\/data.worldbank.org\/indicator\/PA.NUS.FCRF> (2025)."},{"key":"2026051808001392000_2026.05.12.26353029v1.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2023.05.033"},{"key":"2026051808001392000_2026.05.12.26353029v1.53","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-020-00930-6"},{"key":"2026051808001392000_2026.05.12.26353029v1.54","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00069-8"},{"key":"2026051808001392000_2026.05.12.26353029v1.55","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X20937253"},{"key":"2026051808001392000_2026.05.12.26353029v1.56","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-020-1913-9"},{"key":"2026051808001392000_2026.05.12.26353029v1.57","unstructured":"Wrold Bank. GDP per capita (current US$), < https:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.CD> (2025)."}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.05.12.26353029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T15:00:32Z","timestamp":1779116432000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.05.12.26353029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":57,"URL":"https:\/\/doi.org\/10.64898\/2026.05.12.26353029","relation":{},"subject":[],"published":{"date-parts":[[2026,5,15]]},"subtype":"preprint"}}