Model-based assessment of public health impact and cost-effectiveness of routine vaccination against dengue

Guido Camargo Espana

(November 13, 2018 10:20 AM - 11:05 AM)

Model-based assessment of public health impact and cost-effectiveness of routine vaccination against dengue

Abstract

A safe and effective vaccine for dengue could have a major public health impact for billions of people at risk of this mosquito-borne viral disease. Currently, Dengvaxia® from Sanofi Pasteur is the only licensed dengue vaccine but it has shown to be unsafe for individuals who have not been exposed to dengue virus (DENV). The WHO now recommends Dengvaxia® only in people with confirmed prior exposure to DENV. We used an agent-based model to simulate DENV transmission over a 30-year timeframe, with and without vaccination over a range of values of transmission intensity. We projected the proportion cases averted as a function of the sensitivity and specificity of serological screening. We evaluated the cost-effectiveness of this intervention under economic scenarios representative of Brazil and the Philippines.Our findings suggest that public health impact depends primarily on the sensitivity of screening in high-transmission settings and on a combination of sensitivity and specificity in low-transmission settings. Cost-effectiveness could be achievable from the perspective of a public payer provided that screening sensitivity and the value of a disability-adjusted life-year were high. Cost-effectiveness was found from the individual perspective in scenarios with high screening specificity and low coverage.