Use of Insecticide-Treated School Uniforms for Prevention of Dengue in Schoolchildren: A Cost-Effectiveness Analysis

Abstract

BackgroundDengue-related illness is a leading cause of hospitalization and death, particularly among children. Practical, acceptable and affordable measures are urgently needed to protect this age group. Schools where children spend most of their day is proposed as an ideal setting to implement preventive strategies against day-biting Aedes mosquitoes. The use of insecticide-treated school uniforms is a promising strategy currently under investigation.MethodsUsing a decision-analytic model, we evaluated the cost-effectiveness of the use of insecticide-treated school uniforms for prevention of dengue, compared with a “do-nothing” alternative, in schoolchildren from the societal perspective. We explored how the potential economic value of the intervention varied under various scenarios of intervention effectiveness and cost, as well as dengue infection risk in school-aged children, using data specific to Thailand.ResultsAt an average dengue incidence rate of 5.8% per year in school-aged children, the intervention was cost-effective (ICER≤$16,440) in a variety of scenarios when the intervention cost per child was $5.3 or less and the intervention effectiveness was 50% or higher. In fact, the intervention was cost saving (ICER<0) in all scenarios in which the intervention cost per child was $2.9 or less per year and the intervention effectiveness was 50% or higher. The results suggested that this intervention would be of no interest to Thai policy makers when the intervention cost per child was $10.6 or higher per year regardless of intervention effectiveness (ICER>$16,440).ConclusionsOur results present the potential economic value of the use of insecticide-treated uniforms for prevention of dengue in schoolchildren in a typical dengue endemic setting and highlight the urgent need for additional research on this intervention.

Permethrin-Treated Clothing as Protection against the Dengue Vector, Aedes aegypti: Extent and Duration of Protection

“…A cost-effectiveness analysis for an intervention in Thailand suggested a cost greater than $10.6 per child per year would not be of interest to policy makers in Thailand. Using a home dip impregnated kit only once would cost between $5.3-$8 per child per year [ 42 ]. Since home-dipping is likely to require more frequent reapplication, this will increase costs beyond the acceptable limit.…”

Long-Lasting Permethrin-Impregnated Clothing Protects Against Mosquito Bites in Outdoor Workers

“…6 Work by WilderSmith and others indicate that LLPI clothing would be a costeffective and acceptable means of preventing dengue. 34,35 Biomarkers may be the only way to quantitate mosquito bite exposure in field studies. There have been a number of studies on the validity of IgG antibodies against mosquito salivary proteins as biomarkers for mosquito bite exposure.…”

Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia

“…Los diversos estudios de costo-efectividad se han enfocado principalmente en el análisis de intervenciones específicas sobre grupos poblacionales focalizados 20 - 24 . En este sentido, una limitación del presente estudio fue el no haber analizado las estrategias específicas implementadas en cada uno de los municipios, lo que impidió determinar el costo-efectividad a este nivel en población focalizada.…”