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: España, Guido, Leidner, Andrew J., Waterman, Stephen H., Perkins, T. Alex
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341694/
https://www.ncbi.nlm.nih.gov/pubmed/34310614
http://dx.doi.org/10.1371/journal.pntd.0009606
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author España, Guido
Leidner, Andrew J.
Waterman, Stephen H.
Perkins, T. Alex
author_facet España, Guido
Leidner, Andrew J.
Waterman, Stephen H.
Perkins, T. Alex
author_sort España, Guido
collection PubMed
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.
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spelling pubmed-83416942021-08-06 Cost-effectiveness of dengue vaccination in Puerto Rico España, Guido Leidner, Andrew J. Waterman, Stephen H. Perkins, T. Alex PLoS Negl Trop Dis Research Article 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. Public Library of Science 2021-07-26 /pmc/articles/PMC8341694/ /pubmed/34310614 http://dx.doi.org/10.1371/journal.pntd.0009606 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
España, Guido
Leidner, Andrew J.
Waterman, Stephen H.
Perkins, T. Alex
Cost-effectiveness of dengue vaccination in Puerto Rico
title 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_short Cost-effectiveness of dengue vaccination in Puerto Rico
title_sort cost-effectiveness of dengue vaccination in puerto rico
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341694/
https://www.ncbi.nlm.nih.gov/pubmed/34310614
http://dx.doi.org/10.1371/journal.pntd.0009606
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