Abstract
BackgroundEvery year, 90,000 people may die from melioidosis. Vaccine candidates have not proceeded past animal studies, partly due to uncertainty around the potential market size. This study aims to estimate the potential impact, cost-effectiveness and market size for melioidosis vaccines.MethodsAge-structured decision tree models with country-specific inputs were used to estimate net costs and health benefits of vaccination, with health measured in quality-adjusted life years (QALYs). Four target groups of people living in endemic regions were considered: (i) people aged over 45 years with chronic renal disease, (ii) people aged over 45 years with diabetes, (iii) people aged over 45 years with diabetes and/or chronic renal disease, (iv) everyone aged over 45 years. Melioidosis risk was estimated using Bayesian evidence synthesis of 12 observational studies. In the base case, vaccines were assumed to have 80% efficacy, to have 5-year mean protective duration and to cost USD10.20–338.20 per vaccine.ResultsVaccination could be cost-effective (with incremental cost-effectiveness ratio below GDP per capita) in 61/83 countries/territories with local melioidosis transmission. In these 61 countries/territories, vaccination could avert 68,000 lost QALYs, 8300 cases and 4400 deaths per vaccinated age cohort, at an incremental cost of USD59.6 million. Strategy (ii) was optimal in most regions. The vaccine market may be worth USD268 million per year at its threshold cost-effective price in each country/territory.ConclusionsThere is a viable melioidosis vaccine market, with cost-effective vaccine strategies in most countries/territories with local transmission.
Highlights
Every year, 90,000 people may die from melioidosis
Our synthesis of evidence from 12 observational studies indicates that diabetes is the risk factor for melioidosis with the highest relative risk, followed by age over 45 years and chronic renal disease (Table 1)
In the regional analysis, vaccinating diabetics aged over 45 years living in environmentally suitable areas for melioidosis (Vac 2) would be cost-effective in East Asia and the Pacific (EAP), subSaharan Africa (SAF) and SOA (Fig. 2; see Additional file 1: Table S4 and Figure S2 for detailed results)
Summary
Vaccine candidates have not proceeded past animal studies, partly due to uncertainty around the potential market size. This study aims to estimate the potential impact, cost-effectiveness and market size for melioidosis vaccines. The bacteria are present mainly in soil and water, and people are infected through inoculation, ingestion and inhalation [2]. A recent study estimated that melioidosis is endemic in 83 countries/territories (hereafter “geographies”), mainly in South-East Asia and sub-Saharan Africa, and that it causes 164,938 cases and 88,979 deaths annually [3]. Several vaccine candidates have shown promising results in animals but to date no human studies have been conducted [7, 8]. A recent study showed that a melioidosis vaccine could be cost-effective in north-eastern Thailand if it protects for at least 3 years and can reduce both incidence and mortality of melioidosis by at least 80%; the threshold cost-effective price was $1 for vaccinating
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.
