title: Use of insecticide-treated school uniforms for prevention of dengue in schoolchildren: a cost-effectiveness analysis.
abstract: BACKGROUND
  Dengue-related illness is a leading cause of hospitalization and death, particularly among children. Practical, acceptable and affordable measures are urgently needed to protect this age group. Schools where children spend most of their day is proposed as an ideal setting to implement preventive strategies against day-biting Aedes mosquitoes. The use of insecticide-treated school uniforms is a promising strategy currently under investigation.
  
  
  METHODS
  Using a decision-analytic model, we evaluated the cost-effectiveness of the use of insecticide-treated school uniforms for prevention of dengue, compared with a "do-nothing" alternative, in schoolchildren from the societal perspective. We explored how the potential economic value of the intervention varied under various scenarios of intervention effectiveness and cost, as well as dengue infection risk in school-aged children, using data specific to Thailand.
  
  
  RESULTS
  At an average dengue incidence rate of 5.8% per year in school-aged children, the intervention was cost-effective (ICER≤$16,440) in a variety of scenarios when the intervention cost per child was $5.3 or less and the intervention effectiveness was 50% or higher. In fact, the intervention was cost saving (ICER<0) in all scenarios in which the intervention cost per child was $2.9 or less per year and the intervention effectiveness was 50% or higher. The results suggested that this intervention would be of no interest to Thai policy makers when the intervention cost per child was $10.6 or higher per year regardless of intervention effectiveness (ICER>$16,440).
  
  
  CONCLUSIONS
  Our results present the potential economic value of the use of insecticide-treated uniforms for prevention of dengue in schoolchildren in a typical dengue endemic setting and highlight the urgent need for additional research on this intervention.
authors.affiliation: Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York, United States of America.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Tozan
authors.affiliation: Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Pitcha
authors.initials: P
authors.lastname: Ratanawong
authors.affiliation: Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Valérie R
authors.initials: VR
authors.lastname: Louis
authors.affiliation: Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Phatom, Thailand.
authors.forename: Pattamaporn
authors.initials: P
authors.lastname: Kittayapong
authors.affiliation: Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; University of Umea, Umea, Sweden.
authors.forename: Annelies
authors.initials: A
authors.lastname: Wilder-Smith
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D003362:Cost-Benefit Analysis; D003715:Dengue / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007300:Insect Control / Q000191:economics* / Q000379:methods; D007306:Insecticides / Q000008:administration & dosage* / Q000191:economics; D018803:Models, Economic; D011481:Protective Clothing / Q000191:economics*; D013785:Thailand / Q000453:epidemiology
chemical_list: D007306:Insecticides