The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling
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Dengue disease poses a great economic burden in Malaysia.
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.
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.
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.
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.
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
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.
This article does not contain any studies with human participants or animals performed by any of the authors.
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