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PharmacoEconomics

, Volume 35, Issue 5, pp 575–589 | Cite as

The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling

  • Asrul Akmal ShafieEmail author
  • Hui Yee Yeo
  • Laurent Coudeville
  • Lucas Steinberg
  • Balvinder Singh Gill
  • Rohani Jahis
  • Amar-Singh HSS
Original Research Article

Abstract

Background

Dengue disease poses a great economic burden in Malaysia.

Methods

This study evaluated the cost effectiveness and impact of dengue vaccination in Malaysia from both provider and societal perspectives using a dynamic transmission mathematical model. The model incorporated sensitivity analyses, Malaysia-specific data, evidence from recent phase III studies and pooled efficacy and long-term safety data to refine the estimates from previous published studies. Unit costs were valued in $US, year 2013 values.

Results

Six vaccination programmes employing a three-dose schedule were identified as the most likely programmes to be implemented. In all programmes, vaccination produced positive benefits expressed as reductions in dengue cases, dengue-related deaths, life-years lost, disability-adjusted life-years and dengue treatment costs. Instead of incremental cost-effectiveness ratios (ICERs), we evaluated the cost effectiveness of the programmes by calculating the threshold prices for a highly cost-effective strategy [ICER <1 × gross domestic product (GDP) per capita] and a cost-effective strategy (ICER between 1 and 3 × GDP per capita). We found that vaccination may be cost effective up to a price of $US32.39 for programme 6 (highly cost effective up to $US14.15) and up to a price of $US100.59 for programme 1 (highly cost effective up to $US47.96) from the provider perspective. The cost-effectiveness analysis is sensitive to under-reporting, vaccine protection duration and model time horizon.

Conclusion

Routine vaccination for a population aged 13 years with a catch-up cohort aged 14–30 years in targeted hotspot areas appears to be the best-value strategy among those investigated. Dengue vaccination is a potentially good investment if the purchaser can negotiate a price at or below the cost-effective threshold price.

Notes

Acknowledgements

The authors thank the Director General of Health Malaysia for his permission to publish this article. We also acknowledge the technical input and constructive suggestions from the following experts: Dr. Chee Kheong Chong and Dr. Rose Nani Mudin from Disease Control Division, MOH Malaysia. We acknowledge Nicola Truss, inScience Communications, Springer Healthcare, who provided proofreading assistance. This assistance was funded by Sanofi Pasteur.

Author contributions

AAS and HYY designed the study. LC constructed the model. BSG, RJ and A-SHSS advised on the parameterization of the model construction. LS made substantial contribution in the acquisition of data. AAS and HYY assembled the data and did the statistical analysis. HYY wrote the first draft and all authors contributed to further drafts and approved the final manuscript.

Compliance with ethical standards

Funding

This study was supported by an agreement between Sanofi-Aventis Singapore and Universiti Sains Malaysia.

Conflict of interest

HYY and AAS have received research grants from Sanofi-Aventis Singapore Ptd. Lte. LC and LS are employees of Sanofi-Pasteur. BSG and RJ have no conflicts of interest. A-SHSS has received consultation honorarium from Sanofi-Aventis Singapore Ptd. Lte.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

40273_2017_487_MOESM1_ESM.docx (327 kb)
Supplementary material 1 (DOCX 326 kb)
40273_2017_487_MOESM2_ESM.docx (40 kb)
Supplementary material 2 (DOCX 39 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Asrul Akmal Shafie
    • 1
    Email author
  • Hui Yee Yeo
    • 1
  • Laurent Coudeville
    • 2
  • Lucas Steinberg
    • 3
  • Balvinder Singh Gill
    • 4
  • Rohani Jahis
    • 4
  • Amar-Singh HSS
    • 5
  1. 1.Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains Malaysia (USM)George TownMalaysia
  2. 2.Sanofi Pasteur SALyon Cedex 07France
  3. 3.Sanofi Pasteur MalaysiaPetaling JayaMalaysia
  4. 4.Disease Control DivisionMinistry of Health MalaysiaPutrajayaMalaysia
  5. 5.Pediatric Department and Clinical Research CenterHospital Raja Permaisuri Bainun Ipoh, Jalan HospitalIpohMalaysia

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