Cost-effectiveness of dengue vaccination in Puerto Rico

Abstract

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. Author summary: The first dengue vaccine, known as CYD-TDV, is currently under consideration as a public health tool in Puerto Rico, where dengue is endemic. Although the vaccine protects individuals with prior exposure to dengue virus, individuals vaccinated without prior dengue virus infection could experience a higher chance of severe disease. To avoid vaccinating individuals who have not been exposed to dengue virus, screening for prior infection before vaccination is recommended. Understanding the potential impacts of this intervention in specific settings can help public health decision makers to balance economic and health benefits to consider the implementation of this vaccine. In this study, we estimated the impacts of incorporating screening and vaccination in Puerto Rico for the next 10 years. We found that the vaccine could have a positive impact in reducing severe dengue by preventing 5.5% of hospitalizations, but it could also cause 1.6 hospitalizations for every 1,000 vaccinated who had a false-positive screening result. We also found that this intervention could be cost-effective in Puerto Rico at a cost of 382 USD.

Publication information

Originally published in PLOS Neglected Tropical Diseases on 2021-07-26. Original DOI: 10.1371/journal.pntd.0009606.

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