Cost-effectiveness of dengue vaccination in ten endemic countries

Abstract

Following publication of results from two phase-3 clinical trials in 10 countries or territories, endemic countries began licensing the first dengue vaccine in 2015. Using a published mathematical model, we evaluated the cost-effectiveness of dengue vaccination in populations similar to those at the trial sites in those same Latin American and Asian countries. Our main scenarios (30-year horizon, 80% coverage) entailed 3-dose routine vaccinations costing US$20/dose beginning at age 9, potentially supplemented by catch-up programs of 4- or 8-year cohorts. We obtained illness costs per case, dengue mortality, vaccine wastage, and vaccine administration costs from the literature. We estimated that routine vaccination would reduce yearly direct and indirect illness cost per capita by 22% (from US$10.51 to US$8.17) in the Latin American countries and by 23% (from US$5.78 to US$4.44) in the Asian countries. Using a health system perspective, the incremental cost-effectiveness ratio (ICER) averaged US$4,216/disability-adjusted life year (DALY) averted in the five Latin American countries (range: US$666/DALY in Puerto Rico to US$5,865/DALY in Mexico). In the five Asian countries, the ICER averaged US$3,751/DALY (range: US$1,935/DALY in Malaysia to US$5,101/DALY in the Philippines). From a health system perspective, the vaccine proved to be highly cost effective (ICER under one times the per capita GDP) in seven countries and cost effective (ICER 1-3 times the per capita GDP) in the remaining three countries. From a societal perspective, routine vaccination proved cost-saving in three countries. Including catch-up campaigns gave similar ICERs. Thus, this vaccine could have a favorable economic value in sites similar to those in the trials.

The Estimates of the Health and Economic Burden of Dengue in Vietnam

“…There is very little published information regarding the cost of dengue control interventions in Vietnam. It will be important for future studies to evaluate the cost and cost-effectiveness of both the current and novel future interventions 54 , 55 , such as the Dengvaxia ® vaccine 56 , 57 , 58 .…”

What Does the Future Hold for Yellow Fever Virus? (II)

“…Accordingly, new real-time RT-PCR assays discriminating between wild-type and vaccine strains [ 218 ] or specifically detecting vaccinal strains [ 219 ] were recently published. Molecular YFV diagnostics are further challenged by the application of the new chimeric, live- attenuated DENV vaccine Dengvaxia ® in countries that are endemic for YFV such as Brazil [ 274 , 275 , 276 ]. This vaccine is based on a YFV 17D-backbone expressing the prM and E regions of the four DENV serotypes [ 277 ].…”

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

“…20 In particular, a previous study in 10 endemic countries confirmed that dengue vaccination could be highly cost-effective and a cost-effective intervention in 3 and 7 countries, respectively, according to their gross domestic product (GDP) per-capita values. 21 Despite the fact that dengue vaccine has been licensed in several Asian countries and has proven its cost-effectiveness, a postlicensing monitoring and evaluation (eg, monitoring and registration systems for immunization, reporting, and long-term safety assessments) is still required to be implemented. 22 Considering the results from previous studies, it can be summarized that dengue vaccine in many cases has an ability to reduce the transmission of dengue infection in the community.…”