Abstract
Background and aimsDengue fever is a major public health problem in tropical/subtropical regions. Prior economic analyses have predominantly evaluated either vaccination or vector-control programmes in isolation and do not really consider the incremental benefits and cost-effectiveness of mixed strategies and combination control. We estimated the cost-effectiveness of single and combined approaches in Thailand.MethodsThe impacts of different control interventions were analysed using a previously published mathematical model of dengue epidemiology and control incorporating seasonality, age structure, consecutive infection, cross protection, immune enhancement and combined vector-host transmission. An economic model was applied to simulation results to estimate the cost-effectiveness of 4 interventions and their various combinations (6 strategies): i) routine vaccination of 1-year olds; ii) chemical vector control strategies targeting adult and larval stages separately; iii) environmental management/ public health education and awareness [EM/ PHEA]). Payer and societal perspectives were considered. The health burden of dengue fever was assessed using disability-adjusted life-years (DALYs) lost. Costs and effects were assessed for 10 years. Costs were discounted at 3% annually and updated to 2013 United States Dollars. Incremental cost-effectiveness analysis was carried out after strategies were rank-ordered by cost, with results presented in a table of incremental analysis. Sensitivity and scenario analyses were undertaken; and the impact and cost-effectiveness of Wolbachia was evaluated in exploratory scenario analyses.ResultsFrom the payer and societal perspectives, 2 combination strategies were considered optimal, as all other control strategies were dominated. Vaccination plus adulticide plus EM/ PHEA was deemed cost-effective according to multiple cost-effectiveness criteria. From the societal perspective, incremental differences vs. adulticide and EM/ PHEA resulted in costs of $157.6 million and DALYs lost of 12,599, giving an expected ICER of $12,508 per DALY averted. Exploratory scenario analyses showed Wolbachia to be highly cost-effective ($343 per DALY averted) vs. other single control measures.ConclusionsOur model shows that individual interventions can be cost-effective, but that important epidemiological reductions and economic impacts are demonstrated when interventions are combined as part of an integrated approach to combating dengue fever. Exploratory scenario analyses demonstrated the potential epidemiological and cost-effective impact of Wolbachia when deployed at scale on a nationwide basis. Our findings were robust in the face of sensitivity analyses.
Highlights
Dengue fever is a mosquito-borne disease caused by serologically related, but distinct, viruses grouped into four serotypes (DENV-1 to DENV-4)
Dengue Fever, dynamic transmission model, cost-effectiveness research and any views or opinions expressed by the authors are theirs alone
Societal perspective, incremental differences vs. adulticide and EM/ PHEA resulted in costs of $157.6 million and disability-adjusted life years (DALYs) lost of 12,599, giving an expected incremental cost-effectiveness ratio (ICER) of $12,508 per DALY averted
Summary
Dengue fever is a mosquito-borne disease caused by serologically related, but distinct, viruses grouped into four serotypes (DENV-1 to DENV-4). Aedes aegypti mosquitoes are the primary vector of transmission for dengue fever and, to a lesser extent, Aedes albopictus. These mosquitoes are responsible for the transmission of other vector-borne diseases including zika virus, chikungunya and yellow fever. The reasons for the growth in dengue fever and severe dengue as leading public health challenges tend to be multi-factorial [2]. These include rapid population growth, increasing unplanned urbanisation, overseas air travel and deteriorations in public health infrastructure [3,4,5]. We estimated the cost-effectiveness of single and combined approaches in Thailand
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
