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. 2023 Oct-Nov;43(7-8):850-862.
doi: 10.1177/0272989X231191127. Epub 2023 Aug 14.

Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame

Kamran Badizadegan  1 , Dominika A Kalkowska  1 , Kimberly M Thompson  1
Affiliations

Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame

Kamran Badizadegan et al. Med Decis Making. 2023 Oct-Nov.

Abstract

Background: Polio antiviral drugs (PAVDs) may provide a critical tool in the eradication endgame by stopping poliovirus infections in immunodeficient individuals who may not clear the virus without therapeutic intervention. Although prolonged/chronic poliovirus excreters are rare, they represent a source of poliovirus reintroduction into the general population. Prior studies that assumed the successful cessation of all oral poliovirus vaccine (OPV) use estimated the potential upper bound of the incremental net benefits (INBs) of resource investments in research and development of PAVDs. However, delays in polio eradication, OPV cessation, and the development of PAVDs necessitate an updated economic analysis to reevaluate the costs and benefits of further investments in PAVDs.

Methods: Using a global integrated model of polio transmission, immunity, vaccine dynamics, risks, and economics, we explore the risks of reintroduction of polio transmission due to immunodeficiency-related vaccine-derived poliovirus (iVDPV) excreters and reevaluate the upper bound of the INBs of PAVDs.

Results: Under the current conditions, for which the use of OPV will likely continue for the foreseeable future, even with successful eradication of type 1 wild poliovirus by the end of 2023 and continued use of Sabin OPV for outbreak response, we estimate an upper bound INB of 60 million US$2019. With >100 million US$2019 already invested in PAVD development and with the introduction of novel OPVs that are less likely to revert to neurovirulence, our analysis suggests the expected INBs of PAVDs would not offset their costs.

Conclusions: While PAVDs could play an important role in the polio endgame, their expected economic benefits drop with ongoing OPV use and poliovirus transmissions. However, stakeholders may pursue the development of PAVDs as a desired product regardless of their economic benefits.HighlightsWhile polio antiviral drugs could play an important role in the polio endgame, their expected economic benefits continue to drop with delays in polio eradication and the continued use of oral poliovirus vaccines.The incremental net benefits of investments in polio antiviral drug development and screening for immunodeficiency-related circulating polioviruses are small.Limited global resources are better spent on increasing global population immunity to polioviruses to stop and prevent poliovirus transmission.

Keywords: antiviral drugs; disease eradication; modeling; polio; prevention; vaccines.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1:
Figure 1:
Schematic of components of the integrated global model Abbreviations: cVDPV, circulating VDPV; DEB, differential equation-based model; DES, discrete-event simulation model; iVDPV, immunodeficiency-associated vaccine-derived poliovirus; IPV, inactivated poliovirus vaccine; OPV, oral poliovirus vaccine; oSIAs, outbreak supplemental immunization activities; PAVD, polio antiviral drug; pSIAs, preventive supplemental immunization activity; VAPP, vaccine-associated paralytic polio; VDPV, vaccine-derived poliovirus; WPV, wild poliovirus
Figure 2:
Figure 2:
Expected global number of polio cases by year for 100 stochastic iterations of the different PAVD policy choices for the period 2022–2035. Abbreviations: PAVD, polio antiviral drug
See this image and copyright information in PMC

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