Top

Published in:

01-05-2017 | Original Research Article

The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling

Authors: Asrul Akmal Shafie, Hui Yee Yeo, Laurent Coudeville, Lucas Steinberg, Balvinder Singh Gill, Rohani Jahis, Amar-Singh HSS

Published in: PharmacoEconomics | Issue 5/2017

Abstract

Background

Dengue disease poses a great economic burden in Malaysia.

Methods

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.

Results

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.

Conclusion

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.

Available only for authorised users

Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504–7. doi:10.1038/nature12060.CrossRefPubMedPubMedCentral

World Health Organization. Dengue Situation Updates. http://www.wpro.who.int/emerging_diseases/DengueSituationUpdates/en/. Accessed 11 Oct 2016.

Shepard DS, Undurraga EA, Lees RS, Halasa Y, Lum LC, Ng CW. Use of multiple data sources to estimate the economic cost of dengue illness in Malaysia. Am J Trop Med Hyg. 2012;87(5):796–805. doi:10.4269/ajtmh.2012.12-0019.CrossRefPubMedPubMedCentral

Undurraga EA, Halasa YA, Shepard DS. Use of expansion factors to estimate the burden of dengue in southeast Asia: a systematic analysis. PLoS Negl Trop Dis. 2013;7(2):e2056. doi:10.1371/journal.pntd.0002056.CrossRefPubMedPubMedCentral

Horstick O, Runge-Ranzinger S, Nathan MB, Kroeger A. Dengue vector-control services: how do they work? A systematic literature review and country case studies. Trans R Soc Trop Med Hyg. 2010;104(6):379–86. doi:10.1016/j.trstmh.2009.07.027.CrossRefPubMed

Beatty ME, Beutels P, Meltzer MI, Shepard DS, Hombach J, Hutubessy R, et al. Health economics of dengue: a systematic literature review and expert panel’s assessment. Am J Trop Med Hyg. 2011;84(3):473–88. doi:10.4269/ajtmh.2011.10-0521.CrossRefPubMedPubMedCentral

Shepard DS, Suaya JA, Halstead SB, Nathan MB, Gubler DJ, Mahoney RT, et al. Cost-effectiveness of a pediatric dengue vaccine. Vaccine. 2004;22(9):1275–80.CrossRefPubMed

Lee BY, Connor DL, Kitchen SB, Bacon KM, Shah M, Brown ST, et al. Economic value of dengue vaccine in Thailand. Am J Trop Med Hyg. 2011;84(5):764–72. doi:10.4269/ajtmh.2011.10-0624.CrossRefPubMedPubMedCentral

Carrasco LR, Lee LK, Lee VJ, Ooi EE, Shepard DS, Thein TL, et al. Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore. PLoS Negl Trop Dis. 2011;5(12):e1426. doi:10.1371/journal.pntd.0001426.CrossRefPubMedPubMedCentral

10.

Durham DP, Ndeffo Mbah ML, Medlock J, Luz PM, Meyers LA, Paltiel AD, et al. Dengue dynamics and vaccine cost-effectiveness in Brazil. Vaccine. 2013;31(37):3957–61. doi:10.1016/j.vaccine.2013.06.036.CrossRefPubMedPubMedCentral

11.

Shim E. Dengue dynamics and vaccine cost-effectiveness analysis in the Philippines. Am J Trop Med Hyg. 2016;16:0194.

12.

Coudeville L, Garnett GP. Transmission dynamics of the four dengue serotypes in southern Vietnam and the potential impact of vaccination. PLoS One. 2012;7(12):e51244. doi:10.1371/journal.pone.0051244.CrossRefPubMedPubMedCentral

13.

Amar-Singh HSS, Koh M-T, Tan KK, Chan LG, Zhou L, Bouckenooghe A, et al. Safety and immunogenicity of a tetravalent dengue vaccine in healthy children aged 2–11 years in Malaysia: a randomized, placebo-controlled, phase III study. Vaccine. 2013;31(49):5814–21. doi:10.1016/j.vaccine.2013.10.013.CrossRefPubMed

14.

Villar L, Dayan GH, Arredondo-Garcia JL, Rivera DM, Cunha R, Deseda C, et al. Efficacy of a tetravalent dengue vaccine in children in Latin America. N Engl J Med. 2015;372(2):113–23. doi:10.1056/NEJMoa1411037.CrossRefPubMed

15.

Capeding MR, Tran NH, Hadinegoro SRS, Ismail HIHJM, Chotpitayasunondh T, Chua MN, et al. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet. 2014;384(9951):1358–65. doi:10.1016/S0140-6736(14)61060-6.CrossRefPubMed

16.

Hadinegoro SR, Arredondo-García JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, et al. Efficacy and long-term safety of a dengue vaccine in regions of endemic disease. N Engl J Med. 2015;373(13):1195–206. doi:10.1056/NEJMoa1506223.CrossRefPubMed

17.

World Health Organization. Summary of the April 2016 meeting of the Strategic Advisory Group of Experts on immunization (SAGE). Geneva: WHO; 2016. p. 02016.

18.

World Health Organization. Comparative modelling of dengue vaccine public health impact (CMDVI). Geneva: WHO; 2016.

19.

Mohd-Zaki AH, Brett J, Ismail E, L’Azou M. Epidemiology of dengue disease in Malaysia (2000–2012): a systematic literature review. PLoS Negl Trop Dis. 2014;8(11):e3159. doi:10.1371/journal.pntd.0003159.CrossRefPubMedPubMedCentral

20.

UNICEF. State of the world’s children 2015 country statistical information. New York: UNICEF; 2013. http://www.unicef.org/infobycountry/malaysia_statistics.html. Accessed 30 July 2015.

21.

World Health Organization. Managing vaccine wastage at country level: guidelines for programme managers. Geneva: WHO; 2003.

22.

Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LC, Tan LH, et al. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg. 2009;80(5):846–55.CrossRefPubMed

23.

Shepard DS, Undurraga EA, Halasa YA. Economic and disease burden of dengue in southeast Asia. PLoS Negl Trop Dis. 2013;7(2):e2055. doi:10.1371/journal.pntd.0002055.CrossRefPubMedPubMedCentral

24.

International Monetary Fund. World Economic Outlook Database. http://www.imf.org/external/pubs/ft/weo/2014/02/weodata/index.aspx. Accessed 15 Dec 2014.

25.

Malaysia Ministry of Health. Pharmacoeconomic guideline for Malaysia. Putrajaya: MoH; 2012.

26.

Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization; 2001.

27.

Malaysia Ministry of Health. Age-specific annual dengue incidence in Selangor 2003–2013. Putrajaya: MoH; 2014.

28.

Rodriguez-Barraquer I, Mier-y-Teran-Romero L, Schwartz IB, Burke DS, Cummings DA. Potential opportunities and perils of imperfect dengue vaccines. Vaccine. 2014;32(4):514–20.CrossRefPubMed

29.

Halloran ME, Haber M, Longini IM, Struchiner CJ. Direct and indirect effects in vaccine efficacy and effectiveness. Am J Epidemiol. 1991;133(4):323–31.CrossRefPubMed

30.

World Health Organization. Global strategy for dengue prevention and control, 2012–2020 Report no. WHO/HTM/NTD/VEM/2012.5. Geneva: WHO; 2012.

31.

Aljunid S, Zafar A, Saperi S, Amrizal M. Burden of disease associated with cervical cancer in Malaysia and potential costs and consequences of HPV vaccination. Asian Pac J Cancer Prev. 2010;11(6):1551–9.PubMed

32.

Pitman R, Fisman D, Zaric GS, Postma M, Kretzschmar M, Edmunds J, et al. Dynamic transmission modeling: a report of the ISPOR-SMDM modeling good research practices task force-5. Value Health. 2012;15(6):828–34.CrossRefPubMedPubMedCentral

33.

Tu HA, Woerdenbag HJ, Kane S, Rozenbaum MH, Li SC, Postma MJ. Economic evaluations of rotavirus immunization for developing countries: a review of the literature. Expert Rev Vaccines. 2011;10(7):1037–51. doi:10.1586/erv.11.65.CrossRefPubMed

34.

Fesenfeld M, Hutubessy R, Jit M. Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review. Vaccine. 2013;31(37):3786–804. doi:10.1016/j.vaccine.2013.06.060.CrossRefPubMed

35.

Walker DG, Hutubessy R, Beutels P. WHO guide for standardisation of economic evaluations of immunization programmes. Vaccine. 2010;28(11):2356–9.CrossRefPubMed

36.

Shafie AA, Lim YW, Chua GN, Hassali MAA. Exploring the willingness to pay for a quality-adjusted life-year in the state of Penang, Malaysia. Clinicoecon Outcomes Res. 2014;6:473–81. doi:10.2147/CEOR.S67375.CrossRefPubMedPubMedCentral

37.

Lim YW, Shafie AA, Chua GN, Hassali M. Determination of cost-effectiveness threshold for Malaysia. George Town: Universiti Sains Malaysia; 2015.

38.

Department of Statistics Malaysia. Population distribution and basic demographic characteristic report 2010. Putrajaya: DoS; 2011.

39.

Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, et al. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2013;380(9859):2144–62.CrossRef

40.

World Health Organization. Choosing interventions that are cost effective (WHO-CHOICE). Geneva: WHO; 2011. http://www.who.int/choice/cost-effectiveness/inputs/health_service/en/.

41.

Guidelines on the Implementation of the Minimum Wages Order 2012. In: Putrajaya, editor. Ministry of Human Resources. National Wages Consultative Council; 2012.

42.

Ministry of Health Malaysia. Handbook of National Immunization Programme for Babies and Children (for Nurses). Putrajaya: Family Health Promotion Division; 2008.

43.

Coudeville L, Baurin N, Vergu E. Estimation of parameters related to vaccine efficacy and dengue transmission from two large phase III studies. Vaccine. 2015. doi:10.1016/j.vaccine.2015.11.023.CrossRefPubMedPubMedCentral

44.

Nealon JTA, Capeding MR, Tran NH, Hadinegoro SR, Chotpitayasunondh T, et al. Symptomatic dengue burden in 5 countries in Asia-Pacific: epidemiological evidence from a dengue vaccine trial. In: 5th Asian vaccine conference, Hanoi; 2015.

Title: The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling
Authors: Asrul Akmal Shafie
Hui Yee Yeo
Laurent Coudeville
Lucas Steinberg
Balvinder Singh Gill
Rohani Jahis
Amar-Singh HSS
Publication date: 01-05-2017
Publisher: Springer International Publishing
Published in: PharmacoEconomics / Issue 5/2017
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI: https://doi.org/10.1007/s40273-017-0487-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2017

Evolocumab for Treating Primary Hypercholesterolaemia and Mixed Dyslipidaemia: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

Economic Evaluations of New Oral Anticoagulants for the Prevention of Venous Thromboembolism After Total Hip or Knee Replacement: A Systematic Review

Comment on: “Can the EVIDEM Framework Tackle Issues Raised by Evaluating Treatments for Rare Diseases: Analysis of Issues and Policies, and Context-Specific Adaptation”

Can Mapping Algorithms Based on Raw Scores Overestimate QALYs Gained by Treatment? A Comparison of Mappings Between the Roland–Morris Disability Questionnaire and the EQ-5D-3L Based on Raw and Differenced Score Data

Authors’ Reply to Gandjour: “Can the EVIDEM Framework Tackle Issues Raised by Evaluating Treatments for Rare Diseases: Analysis of Issues and Policies, and Context-Specific Adaptation”

Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Systematic Literature Review