Cost-utility analysis of dengue vaccination in a country with heterogeneous risk of dengue transmission |
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| Institution: | 1. Consejo Nacional de Investigaciones Cientificas y Tecnicas, Buenos Aires, Argentina;2. Universidad Tecnologica Nacional, Facultad Regional San Nicolas, San Nicolas, Argentina;3. Hospital Interzonal General de Agudos “San Felipe”, San Nicolas, Argentina;4. Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany;5. Instituto Nacional de Medicina Tropical, Puerto Iguazu, Argentina;1. Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Kasuga-koen, Kasuga-shi, Fukuoka 816-8580, Japan;2. Department of Mathematics, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh;3. Faculty of Engineering Sciences, Kyushu University, Kasuga-koen, Kasuga-shi, Fukuoka 816-8580, Japan;1. Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, MD, USA;2. International Vaccines Institute, Dengue Vaccine Initiative (DVI), Seoul, Korea;3. Gorgas Memorial Institute for Health Studies (GMI), Panama City, Panama;4. Secretary of Health, Vector Borne Diseases Control Division, Mexico City, Mexico;5. Center of Studies and Research in Health, Bogota, Colombia;6. University of the Andes, Bogota, Colombia;7. Sanofi Pasteur, Lyon, France;8. National Autonomous University of Mexico, Mexico City, Mexico;9. Health Services Management, Mexico City, Mexico;10. National Center for Health Technology Excellence, Ministry of Health, Mexico City, Mexico;11. National Institute of Public Health, Mexico City, Mexico;12. Sanofi Pasteur, Washington D.C., USA;13. Ministry of Health, Kingston, Jamaica;14. Pan-American Health Organization, (PAHO), El Salvador City, El Salvador;15. Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil;16. Federal Univeristy of Goiás, Goiás, Brazil;17. Federal University of Pernambuco, Recife, Brazil;1. Vaccination Value Modeling, Sanofi Pasteur, Lyon, France;2. Global Epidemiology, Sanofi Pasteur, Lyon, France;3. Research & Development, Sanofi Pasteur, Lyon, France;1. Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam;2. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;3. London Centre for Neglected Tropical Disease Research, London, UK;4. Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London W2 1 PG, UK;5. Pasteur Institute, Ho Chi Minh City, Vietnam;6. Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA, USA;1. Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, USA;2. United States Public Health Service, Silver Springs, MD, USA;3. Institute for Global Health and Translational Sciences and Department of Medicine, and Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA;4. Department of Virology, Armed Forces Research Institute for Medical Sciences, Bangkok, Thailand;5. Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA;6. Department of Biology, University of Florida, Gainesville, FL, USA;7. Saw Swee Hock School of Public Health, National University of Singapore, Singapore;8. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK;9. Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA |
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| Abstract: | BackgroundDengue is one of the most important vector-borne diseases worldwide, and annually, nearly 390 million people are infected and 500,000 patients are hospitalized for severe dengue. Argentina has great variability in the risk of dengue transmission due to eco-climatic reasons. Currently no vaccines are available for dengue even though several vaccines are under development.ObjectiveThe aim of this study was to estimate the cost-effectiveness of a dengue vaccine in a country with heterogeneous risk of dengue transmission like Argentina.MethodsThe analysis was carried out from a societal perspective using a Markov model that included both vaccine and disease parameters. Utility was measured as disability adjusted life years (DALYs) averted, and the incremental cost-effectiveness ratio (ICER) of the vaccination was expressed in 2014 American dollars (US$) per DALY averted. One-way and probabilistic sensitivity analyses were performed to evaluate uncertainty in model outcomes, and a threshold analysis was conducted to estimate the highest possible price of the vaccine.ResultsThe ICER of the vaccination program was found to be US$ 5714 per DALY averted. This value is lower than 3 times the per capita GDP of Argentina (US$ 38,619 in 2014); 54.9% of the simulations were below this value. If a vaccination program would be implemented the maximum vaccine price per dose has to be US$1.49 for a vaccination at national level or US$28.72 for a targeted vaccination in high transmission areas.ConclusionsThese results demonstrate that vaccination against dengue would be cost-effective in Argentina, especially if carried out in predetermined regions at high risk of dengue transmission. However, these results should be interpreted with caution because the probabilistic sensitivity analysis showed that there was considerable uncertainty around the ICER value. The influence of variations in vaccine efficacy, cost and other important parameters are discussed in the text. |
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| Keywords: | Dengue Dengue vaccines Cost-utility analysis Argentina |
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