Shim Eunha
Department of Mathematics, Soongsil University, Seoul, Republic of Korea.
Am J Trop Med Hyg. 2016 Nov 2;95(5):1137-1147. doi: 10.4269/ajtmh.16-0194. Epub 2016 Sep 6.
Dengue is one of the most problematic vector-borne diseases in the Philippines, with an estimated 842,867 cases resulting in medical costs of $345 million U.S. dollars annually. In December 2015, the first dengue vaccine, known as chimeric yellow fever virus-dengue virus tetravalent dengue vaccine, was approved for use in the Philippines and is given to children 9 years of age. To estimate the cost-effectiveness of dengue vaccination in the Philippines, we developed an age-structured model of dengue transmission and vaccination. Using our model, we compared two vaccination scenarios entailing routine vaccination programs both with and without catch-up vaccination. Our results indicate that the higher the cost of vaccination, the less cost-effective the dengue vaccination program. With the current dengue vaccination program that vaccinates children 9 years of age, dengue vaccination is cost-effective for vaccination costs up to $70 from a health-care perspective and up to $75 from a societal perspective. Under a favorable scenario consisting of 1 year of catch-up vaccinations that target children 9-15 years of age, followed by regular vaccination of 9-year-old children, vaccination is cost-effective at costs up to $72 from a health-care perspective and up to $78 from a societal perspective. In general, dengue vaccination is expected to reduce the incidence of both dengue fever and dengue hemorrhagic fever /dengue shock syndrome. Our results demonstrate that even at relatively low vaccine efficacies, age-targeted vaccination may still be cost-effective provided the vaccination cost is sufficiently low.
登革热是菲律宾最棘手的病媒传播疾病之一，据估计，每年有842,867例病例，造成的医疗费用达3.45亿美元。2015年12月，首款登革热疫苗，即嵌合黄热病毒-登革病毒四价登革热疫苗，在菲律宾获批使用，接种对象为9岁儿童。为评估菲律宾登革热疫苗接种的成本效益，我们建立了一个登革热传播和疫苗接种的年龄结构模型。利用该模型，我们比较了两种疫苗接种方案，即有和没有补种疫苗的常规疫苗接种计划。我们的结果表明，疫苗接种成本越高，登革热疫苗接种计划的成本效益就越低。对于目前为9岁儿童接种疫苗的登革热疫苗接种计划，从医疗保健角度来看，疫苗接种成本高达70美元时具有成本效益，从社会角度来看，高达75美元时具有成本效益。在一种有利的方案下，即对9至15岁儿童进行为期1年的补种疫苗，然后对9岁儿童进行常规接种，从医疗保健角度来看，疫苗接种成本高达72美元时具有成本效益，从社会角度来看，高达78美元时具有成本效益。一般来说，登革热疫苗接种有望降低登革热和登革出血热/登革休克综合征的发病率。我们的结果表明，即使疫苗效力相对较低，只要疫苗接种成本足够低，针对性别的疫苗接种仍可能具有成本效益。
