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

Abstract

Objectives: To review the literature on the cost-effectiveness of dengue vaccination in Southeast Asian countries and possibly to provide recommendations on promoting dengue vaccination in this region. Methods: A systematic search was conducted to identify relevant articles in 3 major databases (ProQuest, American Society of Tropical Medicine and Hygiene, and PubMed). Complete economic evaluation studies, including willingness-to-pay (WTP) studies, that were conducted in any Southeast Asian country were included in this study. Systematic review, nonefull-text, and non-English studies were specifically excluded. Results: Nine selected studies highlighted the economic evaluation of dengue vaccination in Southeast Asian countries by considering many parameters (eg, vaccine cost, vaccine efficacy, cost-effectiveness threshold, economic assessment, public acceptance, and WTP). All studies confirmed that dengue vaccine can be used as a prevention strategy to reduce the incidence rate of dengue cases by providing a variance of high cost-effectiveness values. In addition, communities provided a good assessment, acceptance, and WTP value for the vaccine. Conclusions: The use of dengue vaccine could reduce the burden of disease and economic burden due to dengue infection in Southeast Asian countries. The efficacy of dengue vaccine was estimated to be 50-95% for those <9 years, 9 years, and >9 years. In particular, several studies reported that dengue vaccine could be categorized as a cost-effective intervention in Southeast Asian countries within certain conditions.

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“…Potentially, vaccination is the most effective control strategy against dengue. As a public-health intervention, dengue vaccination has been proven to be cost-effective [42]. However, the introduction of this vaccine tends to be delayed in Indonesia due to the scarcity of local cost-effectiveness studies, inadequate health systems, and financial barriers [43].…”

Multi-criteria decision analysis to prioritize the introduction of new vaccines in Indonesia by using the framework of the strategic multi-attribute ranking tool for vaccines (SMART vaccines)

“…Next to the urgency of a reliable decision-support tool, this pandemic situation urged the government to find innovative ways to finance new vaccines, including COVID-19 vaccine. The government should focus on several potential alternatives to deal with the challenges on prioritizing the introduction of new vaccines, such as through strengthening the routine immunization programs and linking to the agenda of universal health coverage to provide a foundation for future gains; expanding the benefits of vaccination beyond infant and children to other age groups to save more people's lives and ensure long-term prosperity due to the lifelong protection of vaccines; and expanding more fiscal space to finance new vaccination programs and to ensure the sustainability of new programs so that such programs would be financed over the long term and not endanger the sustainability of the Indonesian government's financial position [39,40].…”

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“…However, no specific antiretroviral treatment and vaccines are accepted to be used in hospitals. There are also risks associated with the treatment of patients, which is caused by antibody-dependent effects (ADE) [18].…”

“…According to the study of epidemics of diseases caused by insects found that the World Health Organization, dengue fever is the second most serious mortality rate of the population after malaria [19]. Recently, Thailand has an epidemic of dengue fever very seriously.…”

“…In addition, there are many other countries, such as in the country Brazil, El Salvador, Guatemala, Panama, Venezuela, and three other countries in Southeast Asia, Cambodia, Malaysia, Bhutan, Brunei, East Timor, Indonesia, Myanmar, Philippines, Singapore, and Vietnam. Moreover, Taiwan [19]. Previous studies of dengue outbreaks associated with various predictions such as population (density and urbanization), environmental attributes (transportation and water sources), temporary features (time, season), and climate features (temperature, humidity, and precipitation).…”