title: A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control.
abstract: As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016.
  
  
  
  Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS) impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%). We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06%) and Colombia (0.08%). We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation.
  
  
  
  Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president's proposal. As data continue to be collected, new parameter estimates can be customized in real-time within our user-friendly tool to provide updated estimates on cost-effectiveness of interventions and inform policy decisions in country-specific settings.
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Alfaro-Murillo
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Alyssa S
authors.identifier: 0000-0002-9083-1929
authors.initials: AS
authors.lastname: Parpia
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Meagan C
authors.initials: MC
authors.lastname: Fitzpatrick
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Jules A
authors.initials: JA
authors.lastname: Tamagnan
authors.affiliation: Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, United States of America.
authors.forename: Jan
authors.initials: J
authors.lastname: Medlock
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Martial L
authors.initials: ML
authors.lastname: Ndeffo-Mbah
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Durland
authors.initials: D
authors.lastname: Fish
authors.affiliation: Pediatric Infectious Diseases Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, Costa Rica.
authors.forename: María L
authors.initials: ML
authors.lastname: Ávila-Agüero
authors.affiliation: Programa de Control de Vectores, Ministerio de Salud, San José, Costa Rica.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Marín
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.
authors.forename: Albert I
authors.initials: AI
authors.lastname: Ko
authors.affiliation: Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.|Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D000330:Aedes / Q000235:genetics / Q000821:virology; D000818:Animals; D030801:Animals, Genetically Modified; D001938:Brazil / Q000453:epidemiology; D017691:Caribbean Region / Q000453:epidemiology; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000331:legislation & jurisprudence; D003364:Costa Rica / Q000453:epidemiology; D004196:Disease Outbreaks / Q000191:economics / Q000331:legislation & jurisprudence / Q000517:prevention & control; D005260:Female; D017048:Health Care Costs / Q000331:legislation & jurisprudence; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007223:Infant; D008831:Microcephaly / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000517:prevention & control / Q000821:virology; D000071244:Zika Virus / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology