Serostatus testing and dengue vaccine cost–benefit thresholds
Date
2019-08-21
Journal Title
Journal ISSN
Volume Title
Publisher
Royal Society
Abstract
TheWorld Health Organization (WHO) currently recommends pre-screening
for past infection prior to administration of the only licensed dengue vaccine,
CYD-TDV. Using a threshold modelling analysis, we identify settings where
this guidance prohibits positive net-benefits, and are thus unfavourable.
Generally, however, our model shows test-then-vaccinate strategies can
improve CYD-TDV economic viability: effective testing reduces unnecessary
vaccination costs while increasing health benefits.With sufficiently lowtesting
cost, those trends outweigh additional screening costs, expanding the range of
settings with positive net-benefits. This work highlights two aspects for further
analysis of test-then-vaccinate strategies.We found that starting routine testing
at younger ages could increase benefits; if real tests are shown to sufficiently
address safety concerns, the manufacturer, regulators andWHOshould revisit
guidance restricting use to 9-years-and-older recipients. We also found that
repeat testing could improve return-on-investment (ROI), despite increasing
intervention costs. Thus, more detailed analyses should address questions on
repeat testing and testing periodicity, in addition to real test sensitivity and
specificity. Our results follow from a mathematical model relating ROI to
epidemiology, intervention strategy, and costs for testing, vaccination and
dengue infections.We applied this model to a range of strategies, costs and epidemiological
settings pertinent toCYD-TDV.However, general trendsmay not
apply locally, sowe provide our model and analyses as an R package available
via CRAN, denvax. To apply to their setting, decision-makers need only local
estimates of age-specific seroprevalence and costs for secondary infections.
Description
CITATION: Pearson, C. A. B. et al. 2019. Serostatus testing and dengue vaccine cost–benefit thresholds. Journal of the Royal Society Interface, 16:20190234, doi:10.1098/rsif.2019.0234.
The original publication is available at https://royalsocietypublishing.org
The original publication is available at https://royalsocietypublishing.org
Keywords
Serostatus testing, Dengue -- Vaccination -- Economic aspects, CYD-TDV (Dengvaxia) -- Cost effectiveness -- Mathematical models, Dengue -- Vaccination -- Cost effectiveness -- Mathematical models
Citation
Pearson, C. A. B. et al. 2019. Serostatus testing and dengue vaccine cost–benefit thresholds. Journal of the Royal Society Interface, 16:20190234, doi:10.1098/rsif.2019.0234.