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Cost effectiveness of dengue vaccination following pre-vaccination serological screening in Sri Lanka

Published online by Cambridge University Press:  18 October 2019

Sathira Perera Open the ORCID record for Sathira Perera [Opens in a new window] ,
Denny John Open the ORCID record for Denny John [Opens in a new window]  and
Buddhika Senanayaka
Sathira Perera*
Affiliation:
University of New South Wales, Sydney, Australia Ministry of Health, Colombo, Sri Lanka
Denny John
Affiliation:
Campbell Collaboration, New Delhi, India National Institute of Medical Statistics (NIMS), ICMR, New Delhi, India
Buddhika Senanayaka
Affiliation:
Post Graduate Institute of Medicine, Colombo, Sri Lanka
*
Author for correspondence: Sathira Perera, E-mail: sathira.perera@student.unsw.edu.au
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Abstract

Objective

This study sets an example of an economic evaluation of a model dengue vaccination strategy for Sri Lanka, following a mandatory pre-vaccination screening strategy.

Methods

A decision analytic Markov model was developed to estimate the cost-effectiveness of a predicted dengue vaccination strategy over a time horizon of 10 years. The cost effectiveness of dengue vaccination strategy for seropositive individuals was estimated in terms of incremental cost effectiveness ratio (ICER) (cost per additional quality adjusted life-year [QALY]). District-specific ICER values and the budget impact for dengue vaccine were estimated with appropriate sensitivity analyses, also taking the variability of the pre-vaccination screening test performance into consideration.

Results

The ICER for the predicted vaccination strategy following pre-vaccination screening was 4,382 USD/QALY for Sri Lanka. There was a significant regional variation in vaccine cost effectiveness. The disaggregated regional incidence of dengue and the need to perform pre-vaccination screening affects the cost effectiveness estimates significantly, where a safer version of the vaccine has the potential to become cost saving in high incidence districts.

Conclusions

The cost effectiveness of the predicted dengue vaccination strategy following pre-vaccination screening showed a significant regional variation across the districts of Sri Lanka. District-wise disease incidence and the need for pre-vaccination screening was found to be the most significant factors affecting the cost effectiveness of the vaccine.

Keywords

Cost effectiveness analysisDengue vaccinationLower middle-income countries
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 6 , 2019 , pp. 427 - 435
Copyright
Copyright © Cambridge University Press 2019

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References

1.Shillcutt, SD, Walker, DG, Goodman, CA, Mills, AJ (2009) Cost effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules. Pharmacoeconomics 27, 903–917.CrossRefGoogle ScholarPubMed
2.Ozawa, S, Mirelman, A, Stack, ML, Walker, DG, Levine, OS (2012) Cost-effectiveness and economic benefits of vaccines in low-and middle-income countries: a systematic review. Vaccine 31, 96–108.CrossRefGoogle ScholarPubMed
3.Bhatt, S, Gething, PW, Brady, OJ et al. (2013) The global distribution and burden of dengue. Nature 496, 504–507.CrossRefGoogle ScholarPubMed
4.Stanaway, JD, Shepard, DS, Undurraga, EA et al. (2016) The global burden of dengue: an analysis from the Global Burden of Disease Study. Lancet Infect Dis 16, 712–23.CrossRefGoogle ScholarPubMed
5.Shepard, DS, Undurraga, EA, Halasa, YA, Stanaway, JD (2016) The global economic burden of dengue: a systematic analysis. Lancet Infect Dis 16, 935–41.CrossRefGoogle ScholarPubMed
6.Shepard, DS, Undurraga, EA, Halasa, YA (2013) Economic and disease burden of dengue in Southeast Asia. PLoS Negl Trop Dis 7(2), e2055.CrossRefGoogle ScholarPubMed
7.Epidemiology Unit Ministry of Health Sri Lanka (2017) Dengue Incidence Data. Available at: http://www.epid.gov.lk. Accessed 2019.Google Scholar
8.Thalagala, N, Tissera, H, Palihawadana, P et al. (2016) Costs of dengue control activities and hospitalizations in the public health sector during an epidemic year in urban Sri Lanka. PLoS Negl Trop Dis 10(2), e0004466.CrossRefGoogle ScholarPubMed
9.Senanayake, M, Jayasinghe, S, Wijesundera, D, Manamperi, M (2014) Economic cost of hospitalized non-fatal paediatric dengue at the Lady Ridgeway Hospital for Children in Sri Lanka. Sri Lanka J Child Health 43, 205–207.CrossRefGoogle Scholar
10.World Health Organization (2016) Dengue vaccine: WHO position paper—July 2016. Wkly Epidemiol Rec 91, 349–64.Google Scholar
11.Ferguson, NM, Rodríguez-Barraquer, I, Dorigatti, I et al. (2016) Benefits and risks of the Sanofi-Pasteur dengue vaccine: modeling optimal deployment. Science 353, 1033–1036.CrossRefGoogle ScholarPubMed
12.Villar, L, Dayan, GH, Arredondo-Garcia, JL et al. (2015) Efficacy of a tetravalent dengue vaccine in children in Latin America. N Engl J Med 372, 113–23.CrossRefGoogle ScholarPubMed
13.Hadinegoro, SR, Arredondo-Garcia, JL, Capeding, MR et al. (2015) Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 373, 1195–206.CrossRefGoogle ScholarPubMed
14.Hladish, TJ, Pearson, CA, Chao, DL et al. (2016) Projected impact of dengue vaccination in Yucatan, Mexico. PLoS Negl Trop Dis 5, e0004661.CrossRefGoogle Scholar
15.Aguiar, M, Stollenwerk, N, Halstead, SB (2016) The risks behind Dengvaxia recommendation. Lancet Infect Dis 6, 882–3.CrossRefGoogle Scholar
16.World Health Organization (2018) Revised SAGE recommendation on use of dengue vaccine. Available at: https://www.who.int/immunization/diseases/dengue/revised_SAGE_recommendations_dengue_vaccines_apr2018/en/. Accessed 2019.Google Scholar
17.Sanofi Pasteur (2018) Sanofi Pasteur communication on SAGE recommendation about Dengvaxia® dengue vaccine. Available at: https://www.sanofi.com/en/media-room/articles/2018/sanofi-pasteur-communication-on-sage-recommendation-about-dengvaxia-dengue-vaccine/. Accessed 2019.Google Scholar
18.Lee, BY, Connor, DL, Kitchen, SB et al. (2011) Economic value of dengue vaccine in Thailand. Am J Trop Med Hyg 84, 764–72.CrossRefGoogle ScholarPubMed
19.Carrasco, LR, Lee, LK, Lee, VJ et al. (2011) Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore. PLoS Negl Trop Dis 5, e1426.CrossRefGoogle ScholarPubMed
20.Shim, E (2016) Dengue dynamics and vaccine cost-effectiveness analysis in the Philippines. Am J Trop Med Hyg 95, 1137–47.CrossRefGoogle ScholarPubMed
21.Durham, DP, Ndeffo Mbah, ML, Medlock, J et al. (2013) Dengue dynamics and vaccine cost-effectiveness in Brazil. Vaccine 31, 3957–61.CrossRefGoogle Scholar
22.Ministry of Health Sri Lanka (2012) Guidelines on Management of Dengue Fever and Dengue Haemorrhagic Fever in Adults. Available at: http://www.epid.gov.lk/web/images/pdf/Publication/guidelines_for_the_management_of_df_and_dhf_in_adults.pdf. Accessed 2019.Google Scholar
23.Ministry of Health Sri Lanka (2015) National Health Accounts Sri Lanka. Available at: http://www.health.gov.lk/enWeb/publication/NHA/Sri%20Lanka%20National%20Health%20Accounts%202013.pdf. Accessed 2019.Google Scholar
24.Department of Census and Statistics of Sri Lanka (2015) Sri Lanka Population Statistics. Available at: http://www.statistics.gov.lk/. Accessed 2019.Google Scholar
25.Senaratne, T, Noordeen, F (2014) Diagnosis of dengue in Sri Lanka: improvements to the existing state of the art in the island. Trans R Soc Trop Med Hyg 108, 685–91.CrossRefGoogle ScholarPubMed
26.Fry, SR, Meyer, M, Semple, MG et al. (2011) The diagnostic sensitivity of dengue rapid test assays is significantly enhanced by using a combined antigen and antibody testing approach. PLoS Negl Trop Dis 5, e1199.CrossRefGoogle ScholarPubMed
27.Hadinegoro, SR, Arredondo-García, JL, Capeding, MR et al. (2015) Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med 373, 1195–206.CrossRefGoogle ScholarPubMed
28.Shim, E (2017) Cost-effectiveness of dengue vaccination programs in Brazil. Am J Trop Med Hyg 96, 1227–34.CrossRefGoogle Scholar
29.Karnon, J, Vanni, T (2011) Calibrating models in economic evaluation: a comparison of alternative measures of goodness of fit, parameter search strategies and convergence criteria. Pharmacoeconomics 29(1), 51–62.CrossRefGoogle ScholarPubMed
30.Vanni, T, Karnon, J, Madan, J et al. (2011) Calibrating models in economic evaluation: a seven-step approach. Pharmacoeconomics 29, 35–49.CrossRefGoogle ScholarPubMed
31.Fitzpatrick, C, Haines, A, Bangert, M et al. (2017) An economic evaluation of vector control in the age of a dengue vaccine. PLoS Negl Trop Dis 11, e0005785.CrossRefGoogle ScholarPubMed