Cost-Effectiveness of a Dengue Vaccine in Southeast Asia and Panama: Preliminary Estimates
To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and calibrated a cost-effectiveness model of vaccinating children at 15 months in Southeast Asia and Panama using a societal perspective. We assumed that full im
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Springer Science+Business Media LLC 2010 (USA)
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Cost-Effectiveness of a Dengue Vaccine in Southeast Asia and Panama: Preliminary Estimates
Abstract: To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and calibrated a cost-effectiveness model of vaccinating children at 15 months in Southeast Asia and Panama using a societal perspective. We assumed that full immunization would require two doses. In Southeast Asia, the gross cost per vaccinee would be US $8.28. Due to projected savings in dengue treatment, the net cost per capita would be 89% below the gross cost. The cost per disability adjusted life year (DALY) saved by a pediatric vaccine would be $50, making the potential vaccine highly cost-effective. In Panama, where we assumed a higher price per dose ($5), the gross cost per vaccinee would be $19.70 for infants and $26.70 in a catch up program for adults. As projected treatment costs are higher, however, averaging $154.27 when discounted to the time of vaccination, the estimated cost offsets would be 178% of vaccination costs for infants and 138% for adults. Thus the dengue vaccination appears to be cost saving under our most likely assumptions. Many uncertainties remain, however, until more epidemiological and economic data are obtained and vaccine development proceeds further. List of Abbreviations: CS, cost saving; DALYS, disability adjusted life years; DF, dengue fever; DHF, dengue hemorrhagic fever; DPT3, diphtheria pertussis tetanus (dose 3); DSS, dengue shock syndrome; GAVI, Global Alliance for Vaccines and Immunization; GNI, gross national income; HBV, hepatitis B vaccine; HIB, hemophilus influenza B; PAHO, Pan American Health Organization; SE Asia, Southeast Asia; WHO, World Health Organization
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Introduction
Dengue is a mosquito-borne disease which threatens half the world’s population (Strobel and Lamaury, 2001). Epidemiological publications and surveillance reports have documented the sobering increase in cases and deaths from dengue (Strobel and Lamaury, 2001) and its spread to new areas, such as the Middle East and the US states of Texas (Gubler, 1998), (Centers for Disease Control, 2002) and Hawaii (Centers for Disease Control, 2002), and Paraguay (BBC, 2007). In the Americas, major outbreaks occurred in 2002 and 2007 with about one million cases reported in each outbreak (Pan American Health Organization, 2008) greatly increasing the importance of effective control programs. As of 2008, the National Institutes of Health have a product in Phase 1 testing, and both Glaxo Smith Kline and Sanofi Pasteur have candidate vaccines in Phase 2 clinical testing, and other developers are conducting laboratory research (Pediatric Dengue Vaccine Initiative (PDVI), 2008). To help guide stakeholders around continued investment in the development and potential use of a dengue vaccine, this paper uses and extends the authors, previous work on its cost-effectiveness in Southeast Asia (SE Asia) (Shepard et al., 2004). Periodically, economic analyses are c
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