Cost-effectiveness of dengue vaccination in Yucatán, Mexico using a dynamic dengue transmission model

Abstract

BackgroundThe incidence of dengue fever (DF) is steadily increasing in Mexico, burdening health systems with consequent morbidities and mortalities. On December 9th, 2015, Mexico became the first country for which the dengue vaccine was approved for use. In anticipation of a vaccine rollout, analysis of the cost-effectiveness of the dengue vaccination program that quantifies the dynamics of disease transmission is essential.MethodsWe developed a dynamic transmission model of dengue in Yucatán, Mexico and its proposed vaccination program to incorporate herd immunity into our analysis of cost-effectiveness analysis. Our model also incorporates important characteristics of dengue epidemiology, such as clinical cross-immunity and susceptibility enhancement upon secondary infection. Using our model, we evaluated the cost-effectiveness and economic impact of an imperfect dengue vaccine in Yucatán, Mexico.ConclusionsOur study indicates that a dengue vaccination program would prevent 90% of cases of symptomatic DF incidence as well as 90% of dengue hemorrhagic fever (DHF) incidence and dengue-related deaths annually. We conclude that a dengue vaccine program in Yucatán, Mexico would be very cost-effective as long as the vaccination cost per individual is less than $140 and $214 from health care and societal perspectives, respectively. Furthermore, at an exemplary vaccination cost of $250 USD per individual on average, dengue vaccination is likely to be cost-effective 43% and 88% of the time from health care and societal perspectives, respectively.

Economic Evaluations of Dengue Vaccination in the Southeast Asia Region: Evidence From a Systematic Review

“…Most of the studies in this area applied a Markov simulation model and dynamic transmission model, which took herd immunity into account. 32,38,42 The models differed in assumptions and parameters related to the natural history and ecology of dengue in both humans and mosquitoes. 24 All included studies targeted a population group that had a relatively high risk of dengue infection in all settings (hospitals, communities, or households), which can be extrapolated into the general population.…”

Optimal bed net use for a dengue disease model with mosquito seasonal pattern

“…However, the first dengue vaccine to be approved is still in phase of follow‐up . Simulations of vaccine introduction in Yucatán (Mexico) displayed its potential to reduce both the number of severe infections and the budget related with the disease . On the other hand, it has been shown, through dengue models fit to data from Asian and Latin American trials, that vaccine efficacy strongly depends on the age of the vaccinated group, transmission intensity, and serostatus at baseline.…”

Model-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposure

“…With respect to economic considerations, our results indicate that serological screening, and vaccination in the event of a positive result, could be cost-effective only under certain circumstances. Assuming as others have [46][47][48] that decisions about cost-effectiveness are made in reference to a multiplier between per capita GDP and costDALY, our results predict that cost-effectiveness could be achieved only in high-transmission areas of dengue-endemic 20 countries with a relatively high per capita GDP, such as Panamá (13,680 USD), Brazil (8,649 USD), México (8,201 USD), or Thailand (5,807 USD) [39]. In the event that CYD-TDV vaccination is recommended in a country but remains unfunded, it is likely that coverage and impact will be low, similar to varicella vaccines in Australia and Canada [49][50][51].…”