Cost-effectiveness of dengue vaccination in Yucatán, Mexico using a dynamic dengue transmission model.

Eunha Shim,Daniela Flavia Hozbor

doi:10.1371/journal.pone.0175020

Abstract

BackgroundThe incidence of dengue fever (DF) is steadily increasing in Mexico, burdening health systems with consequent morbidities and mortalities. On December 9th, 2015, Mexico became the first country for which the dengue vaccine was approved for use. In anticipation of a vaccine rollout, analysis of the cost-effectiveness of the dengue vaccination program that quantifies the dynamics of disease transmission is essential.MethodsWe developed a dynamic transmission model of dengue in Yucatán, Mexico and its proposed vaccination program to incorporate herd immunity into our analysis of cost-effectiveness analysis. Our model also incorporates important characteristics of dengue epidemiology, such as clinical cross-immunity and susceptibility enhancement upon secondary infection. Using our model, we evaluated the cost-effectiveness and economic impact of an imperfect dengue vaccine in Yucatán, Mexico.ConclusionsOur study indicates that a dengue vaccination program would prevent 90% of cases of symptomatic DF incidence as well as 90% of dengue hemorrhagic fever (DHF) incidence and dengue-related deaths annually. We conclude that a dengue vaccine program in Yucatán, Mexico would be very cost-effective as long as the vaccination cost per individual is less than $140 and $214 from health care and societal perspectives, respectively. Furthermore, at an exemplary vaccination cost of $250 USD per individual on average, dengue vaccination is likely to be cost-effective 43% and 88% of the time from health care and societal perspectives, respectively.

Highlights

Dengue fever (DF) is a febrile illness that is caused by any one of four serotypes of flavivirus (DENV-1, DENV-2, DENV-3, and DENV-4) that cross-react immunologically
Our study indicates that a dengue vaccination program would prevent 90% of cases of symptomatic DF incidence as well as 90% of dengue hemorrhagic fever (DHF) incidence and dengue-related deaths annually
We conclude that a dengue vaccine program in Yucatan, Mexico would be very cost-effective as long as the vaccination cost per individual is less than $140 and $214 from health care and societal perspectives, respectively

Summary

Introduction

Dengue fever (DF) is a febrile illness that is caused by any one of four serotypes of flavivirus (DENV-1, DENV-2, DENV-3, and DENV-4) that cross-react immunologically. Dengue is endemic in more than 100 countries, causing more than 390 million infections annually, 96 million of which are clinical dengue infections [1,2,3,4]. People who have had a single primary infection have a higher risk of developing dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) upon a second infection, a phenomenon attributed to antibody-dependent enhancement (ADE) [3, 6]. Mild dengue disease and DF contribute to more than half of the total public health burden of dengue-associated illnesses [7], the more serious manifestations of DHF and DSS are the major impetuses behind emerging efforts to prevent infection [8]. Editor: Daniela Flavia Hozbor, Universidad Nacional de la Plata, ARGENTINA

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