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. 2017 May;96(5):1227-1234.
doi: 10.4269/ajtmh.16-0810.

Cost-Effectiveness of Dengue Vaccination Programs in Brazil

Eunha Shim  1
Affiliations

Cost-Effectiveness of Dengue Vaccination Programs in Brazil

Eunha Shim. Am J Trop Med Hyg. 2017 May.

Abstract

AbstractThe first approved dengue vaccine, CYD-TDV, a chimeric, live-attenuated, tetravalent dengue virus vaccine, was recently licensed in 13 countries, including Brazil. In light of recent vaccine approval, we modeled the cost-effectiveness of potential vaccination policies mathematically based on data from recent vaccine efficacy trials that indicated that vaccine efficacy was lower in seronegative individuals than in seropositive individuals. In our analysis, we investigated several vaccination programs, including routine vaccination, with various vaccine coverage levels and those with and without large catch-up campaigns. As it is unclear whether the vaccine protects against infection or just against disease, our model incorporated both direct and indirect effects of vaccination. We found that in the presence of vaccine-induced indirect protection, the cost-effectiveness of dengue vaccination decreased with increasing vaccine coverage levels because the marginal returns of herd immunity decreases with vaccine coverage. All routine dengue vaccination programs that we considered were cost-effective, reducing dengue incidence significantly. Specifically, a routine dengue vaccination of 9-year-olds would be cost-effective when the cost of vaccination per individual is less than $262. Furthermore, the combination of routine vaccination and large catch-up campaigns resulted in a greater reduction of dengue burden (by up to 93%) than routine vaccination alone, making it a cost-effective intervention as long as the cost per course of vaccination is $255 or less. Our results show that dengue vaccination would be cost-effective in Brazil even with a relatively low vaccine efficacy in seronegative individuals.

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Figures

Figure 1.
Figure 1.
Expected yearly incidence of symptomatic cases of dengue per 100,000 for the different vaccination strategies. Incidence was averaged over a 10-year period. Percentage values refer to the percent reduction in dengue cases compared with dengue incidence in the prevaccine era. Each vaccination strategy is indicated by the age of routine vaccination with its coverage levels and the target ages in the catch-up campaign. For example, R9 (70%) and 9–25 refer to a catch-up campaign of individuals from 9- to 25-year-olds followed by routine vaccination at 9-year-olds with a coverage level of 70%. For all catch-up campaigns considered, 50% vaccine coverage was assumed.
Figure 2.
Figure 2.
Expected yearly incidence of dengue hemorrhagic fever per million for the different vaccination strategies. Incidence was averaged over a 10-year period. Percentage values refer to the percent reduction in dengue cases compared with dengue incidence in the prevaccine era. Each vaccination strategy is indicated by the age of routine vaccination with its coverage levels and the target ages in the catch-up campaign. For example, R9 (70%) and 9–25 refers to a catch-up campaign of individuals from 9- to 25-year-olds followed by routine vaccination at 9-year-olds with a coverage level of 70%. For all catch-up campaigns considered, 50% vaccine coverage was assumed.
Figure 3.
Figure 3.
Age distributions of dengue fever (DF) and dengue hemorrhagic fever (DHF) cases in the prevaccine era. Age-specific incidence rates of DF and DHF cases in the prevaccine era are presented. An annual incidence of dengue fever and DHF cases are 1.07% and 0.029%, respectively.
Figure 4.
Figure 4.
Age distributions of dengue fever (DF) and dengue hemorrhagic fever (DHF) cases after a 10-year period when routine vaccination of 9-year-olds are in practice. After 10 years of routine vaccination of 9-year-olds, the relative incidence of DF decreased among 9- to 18-year-olds by 4%, whereas it increased among individuals over 36–year-olds. The relative incidence of DHF increased by 1% in 9- to 18-year-olds and those over 36-year-olds.
Figure 5.
Figure 5.
Cost-effectiveness of routine dengue vaccination with various coverage levels. The routine dengue vaccination of 9-year-olds was considered with 50%, 70%, and 90% vaccine coverage levels.
Figure 6.
Figure 6.
Cost-effectiveness of a catch-up campaign followed by routine dengue vaccination. One year of a catch-up campaign with various target ages (9–18, 9–24, and 9–34) followed by routine dengue vaccination of 9-year-olds was considered. For catch-up campaigns, 50% vaccine coverage was assumed, whereas 70% vaccine coverage was used for routine vaccination.
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