Dengue Vaccination: Public Health and Economic Impact Analysis in Paraguay

Abstract

Background. Dengue is an increasing health concern in Paraguay. In 2013, it had the highest disease incidence in the Americas with 2301 cases per 100,000 habitants and 252 deaths reported. The average 2010-2013 dengue hospitalization rate reached 11.73%. A tetravalent dengue vaccine (CYD-TDV) has been licensed in four countries to date. We assessed the public health impact and cost-effectiveness of this vaccine in hyper-endemic regions in Paraguay, representing 53% of the national population. Methods. We populated a serotype-specific dengue dynamic transmission model with Paraguay-specific demographic, epidemiology, vector control and cost data from literature and government record reviews. The impact of various vaccination strategies was modelled over a 10-year period. Both societal and public payer perspectives were considered. A 3% discount rate was applied for health outcomes and costs. All costs were expressed in US$2014. Sensitivity analyses were performed to test the uncertainty of input parameters. Results. Without vaccination, 1.7million dengue cases from 2017-2026 were projected to occur in the hyper endemic regions. Routine vaccination of age 9 years (R9), starting in 2017, was predicted to decrease the number of dengue cases by 23% (95% CI: 8-46). This decrease reached 72% (95% CI: 43-95) with the addition of a catch up campaign from 10 to 45 years (R9&10-45). These two vaccination strategies, R9 and R9&10-45, would save US$50 million and US$154 million, respectively, from the societal perspective, by reducing both direct and indirect disease costs. We estimated the cost-effective vaccine price threshold per dose, considering the <3x GDP per capita threshold defined inWHO guidelines, to be up to US$150 (55-251) and US$126 (45-212) from the societal and public payer perspectives, respectively, over 10-year period. Conclusion. Introducing a vaccination program has the potential to significantly decrease the current burden of dengue in Paraguay. The high vaccine price thresholds per dose demonstrate the significant economic value of dengue vaccination in this country. These findings are expected to help policy-makers deciding on the introduction of dengue vaccine in public programs.