Cost-effectiveness of dengue vaccination in Brazil

Abstract

Objective: To define the economic value of a tetravalent dengue vaccine in Brazil by estimating the cost-effectiveness vaccine price threshold per dose. Methods: A dengue dynamic transmission model was used to estimate the public health impact of dengue vaccination and related economic parameters. Two vaccination strategies were assessed: routine vaccination at 9 years old plus ei[1]ther a catch-up campaign of 7 cohorts (10 to 16 years old; R9&10-16) or 16 cohorts (10 to 25 years old; R9&10-25). Brazilian-specific demographic, epidemiological and economic data were used. The economic impact over 10 years was estimated from the public payer and societal perspectives. All costs were expressed in BRL2016. Results: Over 10 years, the R9&10-16 and R9&10-25 vaccination strategies would prevent 9 million and 15 million dengue cases, respectively, avoiding 269,906 (95% CI: 410,097–154,653) and 434,334 (95% CI: 547,052–304,799) disability-adjusted life years. This would result in savings of up to BRL7.4 billion (US$2.1 billion) from a societal perspective with the larger vaccination program. The cost-effective vaccine price threshold per dose for the R9&10-16 and R9&10-25 strategies would be BRL187.5 (95% CI: 109–276) (US$52.1) and BRL183.6 (95% CI: 129–230) (US$51.0), respectively, from the public payer perspective, and BRL221.5 (95% CI: 129–326) (US$61.5) and BRL216.8 (95% CI: 153–271) (US$60.2), respectively, from the societal perspective. Conclusion: The high threshold of vaccine price per dose demonstrates the significant economic value of dengue vaccination in Brazil, even for a large program with 16 catch-up cohorts.