title: Dengue dynamics and vaccine cost-effectiveness in Brazil.
abstract: Recent Phase 2b dengue vaccine trials have demonstrated the safety of the vaccine and estimated the vaccine efficacy with further trials underway. In anticipation of vaccine roll-out, cost-effectiveness analysis of potential vaccination policies that quantify the dynamics of disease transmission are fundamental to the optimal allocation of available doses. We developed a dengue transmission and vaccination model and calculated, for a range of vaccination costs and willingness-to-pay thresholds, the level of vaccination coverage necessary to sustain herd-immunity, the price at which vaccination is cost-effective and is cost-saving, and the sensitivity of our results to parameter uncertainty. We compared two vaccine efficacy scenarios, one a more optimistic scenario and another based on the recent lower-than-expected efficacy from the latest clinical trials. We found that herd-immunity may be achieved by vaccinating 82% (95% CI 58-100%) of the population at a vaccine efficacy of 70%. At this efficacy, vaccination may be cost-effective for vaccination costs up to US$ 534 (95% CI $369-1008) per vaccinated individual and cost-saving up to $204 (95% CI $39-678). At the latest clinical trial estimates of an average of 30% vaccine efficacy, vaccination may be cost-effective and cost-saving at costs of up to $237 (95% CI $159-512) and $93 (95% CI $15-368), respectively. Our model provides an assessment of the cost-effectiveness of dengue vaccination in Brazil and incorporates the effect of herd immunity into dengue vaccination cost-effectiveness. Our results demonstrate that at the relatively low vaccine efficacy from the recent Phase 2b dengue vaccine trials, age-targeted vaccination may still be cost-effective provided the total vaccination cost is sufficiently low.
authors.affiliation: Yale School of Public Health, Yale University, New Haven, CT, United States. david.durham@yale.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Durham
authors.forename: Martial L
authors.initials: ML
authors.lastname: Ndeffo Mbah
authors.forename: Jan
authors.initials: J
authors.lastname: Medlock
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Meyers
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003715:Dengue / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D053059:Dengue Vaccines / Q000191:economics*; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs / Q000191:economics; D018803:Models, Economic; D008962:Models, Theoretical; D014611:Vaccination / Q000191:economics*
chemical_list: D053059:Dengue Vaccines
keywords: Cost-effectiveness; Dengue; Modeling; Vaccine