Cost-effectiveness of dengue vaccination in Puerto Rico.

An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prio...

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Autores principales:	Guido España, Andrew J Leidner, Stephen H Waterman, T Alex Perkins
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/2e34002b38d04636b6e0121621a58d7c
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spelling	oai:doaj.org-article:2e34002b38d04636b6e0121621a58d7c2021-11-25T06:33:28ZCost-effectiveness of dengue vaccination in Puerto Rico.1935-27271935-273510.1371/journal.pntd.0009606https://doaj.org/article/2e34002b38d04636b6e0121621a58d7c2021-07-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009606https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees who had no prior dengue virus infection, the vaccine had a modestly elevated risk of hospitalization and severe disease. The WHO therefore recommended a strategy of pre-vaccination screening and vaccination of seropositive persons. To estimate the cost-effectiveness and benefits of this intervention (i.e., screening and vaccination of seropositive persons) in Puerto Rico, we simulated 10 years of the intervention in 9-year-olds using an agent-based model. Across the entire population, we found that 5.5% (4.6%-6.3%) of dengue hospitalizations could be averted. However, we also found that 0.057 (0.045-0.073) additional hospitalizations could occur for every 1,000 people in Puerto Rico due to DENV-naïve children who were vaccinated following a false-positive test results for prior exposure. The ratio of the averted hospitalizations among all vaccinees to additional hospitalizations among DENV-naïve vaccinees was estimated to be 19 (13-24). At a base case cost of vaccination of 382 USD, we found an incremental cost-effectiveness ratio of 122,000 USD per QALY gained. Our estimates can provide information for considerations to introduce the CYD-TDV vaccine in Puerto Rico.Guido EspañaAndrew J LeidnerStephen H WatermanT Alex PerkinsPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 7, p e0009606 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Guido España Andrew J Leidner Stephen H Waterman T Alex Perkins Cost-effectiveness of dengue vaccination in Puerto Rico.
description	An effective and widely used vaccine could reduce the burden of dengue virus (DENV) around the world. DENV is endemic in Puerto Rico, where the dengue vaccine CYD-TDV is currently under consideration as a control measure. CYD-TDV has demonstrated efficacy in clinical trials in vaccinees who had prior dengue virus infection. However, in vaccinees who had no prior dengue virus infection, the vaccine had a modestly elevated risk of hospitalization and severe disease. The WHO therefore recommended a strategy of pre-vaccination screening and vaccination of seropositive persons. To estimate the cost-effectiveness and benefits of this intervention (i.e., screening and vaccination of seropositive persons) in Puerto Rico, we simulated 10 years of the intervention in 9-year-olds using an agent-based model. Across the entire population, we found that 5.5% (4.6%-6.3%) of dengue hospitalizations could be averted. However, we also found that 0.057 (0.045-0.073) additional hospitalizations could occur for every 1,000 people in Puerto Rico due to DENV-naïve children who were vaccinated following a false-positive test results for prior exposure. The ratio of the averted hospitalizations among all vaccinees to additional hospitalizations among DENV-naïve vaccinees was estimated to be 19 (13-24). At a base case cost of vaccination of 382 USD, we found an incremental cost-effectiveness ratio of 122,000 USD per QALY gained. Our estimates can provide information for considerations to introduce the CYD-TDV vaccine in Puerto Rico.
format	article
author	Guido España Andrew J Leidner Stephen H Waterman T Alex Perkins
author_facet	Guido España Andrew J Leidner Stephen H Waterman T Alex Perkins
author_sort	Guido España
title	Cost-effectiveness of dengue vaccination in Puerto Rico.
title_short	Cost-effectiveness of dengue vaccination in Puerto Rico.
title_full	Cost-effectiveness of dengue vaccination in Puerto Rico.
title_fullStr	Cost-effectiveness of dengue vaccination in Puerto Rico.
title_full_unstemmed	Cost-effectiveness of dengue vaccination in Puerto Rico.
title_sort	cost-effectiveness of dengue vaccination in puerto rico.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/2e34002b38d04636b6e0121621a58d7c
work_keys_str_mv	AT guidoespana costeffectivenessofdenguevaccinationinpuertorico AT andrewjleidner costeffectivenessofdenguevaccinationinpuertorico AT stephenhwaterman costeffectivenessofdenguevaccinationinpuertorico AT talexperkins costeffectivenessofdenguevaccinationinpuertorico
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Cost-effectiveness of dengue vaccination in Puerto Rico.

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