title: The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling.
abstract: BACKGROUND
  Dengue disease poses a great economic burden in Malaysia.
  
  
  METHODS
  This study evaluated the cost effectiveness and impact of dengue vaccination in Malaysia from both provider and societal perspectives using a dynamic transmission mathematical model. The model incorporated sensitivity analyses, Malaysia-specific data, evidence from recent phase III studies and pooled efficacy and long-term safety data to refine the estimates from previous published studies. Unit costs were valued in $US, year 2013 values.
  
  
  RESULTS
  Six vaccination programmes employing a three-dose schedule were identified as the most likely programmes to be implemented. In all programmes, vaccination produced positive benefits expressed as reductions in dengue cases, dengue-related deaths, life-years lost, disability-adjusted life-years and dengue treatment costs. Instead of incremental cost-effectiveness ratios (ICERs), we evaluated the cost effectiveness of the programmes by calculating the threshold prices for a highly cost-effective strategy [ICER <1 × gross domestic product (GDP) per capita] and a cost-effective strategy (ICER between 1 and 3 × GDP per capita). We found that vaccination may be cost effective up to a price of $US32.39 for programme 6 (highly cost effective up to $US14.15) and up to a price of $US100.59 for programme 1 (highly cost effective up to $US47.96) from the provider perspective. The cost-effectiveness analysis is sensitive to under-reporting, vaccine protection duration and model time horizon.
  
  
  CONCLUSIONS
  Routine vaccination for a population aged 13 years with a catch-up cohort aged 14-30 years in targeted hotspot areas appears to be the best-value strategy among those investigated. Dengue vaccination is a potentially good investment if the purchaser can negotiate a price at or below the cost-effective threshold price.
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, George Town, Penang, Malaysia. aakmal@usm.my.
authors.forename: Asrul Akmal
authors.initials: AA
authors.lastname: Shafie
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), 11800, George Town, Penang, Malaysia.
authors.forename: Hui Yee
authors.initials: HY
authors.lastname: Yeo
authors.affiliation: Sanofi Pasteur SA, 2 Avenue Pont Pasteur, 69367, Lyon Cedex 07, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Coudeville
authors.affiliation: Sanofi Pasteur Malaysia, Unit TB-18-1, Level 18, Tower B, Plaza 33, No. 1 Jalan Kemajuan, Seksyen 13, 46200, Petaling Jaya, Selangor, Malaysia.
authors.forename: Lucas
authors.initials: L
authors.lastname: Steinberg
authors.affiliation: Disease Control Division, Ministry of Health Malaysia, Block E1, E3, E6, E7 and E10, Parcel E, Federal Government Administration Centre, 62590, Putrajaya, Malaysia.
authors.forename: Balvinder Singh
authors.initials: BS
authors.lastname: Gill
authors.affiliation: Disease Control Division, Ministry of Health Malaysia, Block E1, E3, E6, E7 and E10, Parcel E, Federal Government Administration Centre, 62590, Putrajaya, Malaysia.
authors.forename: Rohani
authors.initials: R
authors.lastname: Jahis
authors.affiliation: Pediatric Department and Clinical Research Center, Hospital Raja Permaisuri Bainun Ipoh, Jalan Hospital, 30990, Ipoh, Perak, Malaysia.
authors.lastname: Amar-Singh Hss
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003715:Dengue / Q000191:economics / Q000517:prevention & control*; D053059:Dengue Vaccines / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D008296:Malaysia; D008962:Models, Theoretical; D014611:Vaccination / Q000191:economics / Q000379:methods; D055815:Young Adult
chemical_list: D053059:Dengue Vaccines