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dc.contributor.authorEspaña, Guido
dc.contributor.authorAnderson, Kathryn B.
dc.contributor.authorFitzpatrick, Meagan C.
dc.contributor.authorYao, Yutong
dc.creatorEspaña, G.
dc.date.accessioned2019-08-07T12:37:08Z
dc.date.available2019-08-07T12:37:08Z
dc.date.issued2019-07-01
dc.identifier.urihttp://hdl.handle.net/10713/10266
dc.description.abstractThe tetravalent dengue vaccine CYD-TDV (Dengvaxia) is the first licensed vaccine against dengue, but recent findings indicate an elevated risk of severe disease among vaccinees without prior dengue virus (DENV) exposure. The World Health Organization currently recommends CYD-TDV only for individuals with serological confirmation of past DENV exposure. Our objective was to evaluate the potential health impact and cost-effectiveness of vaccination following serological screening. To do so, we used an agent-based model to simulate DENV transmission with and without vaccination over a 10-year timeframe. Across a range of values for the proportion of vaccinees with prior DENV exposure, we projected the proportion of symptomatic and hospitalized cases averted as a function of the sensitivity and specificity of serological screening. Scenarios about the cost-effectiveness of screening and vaccination were chosen to be representative of Brazil and the Philippines. We found that public health impact depended primarily on sensitivity in high-transmission settings and on specificity in low-transmission settings. Cost-effectiveness could be achievable from the perspective of a public payer provided that sensitivity and the value of a disability-adjusted life-year were both high, but only in high-transmission settings. Requirements for reducing relative risk and achieving cost-effectiveness from an individual perspective were more restricted, due to the fact that those who test negative pay for screening but receive no benefit. Our results predict that cost-effectiveness could be achieved only in high-transmission areas of dengue-endemic countries with a relatively high per capita GDP, such as Panamá (13,680 USD), Brazil (8,649 USD), México (8,201 USD), or Thailand (5,807 USD). In conclusion, vaccination with CYD-TDV following serological screening could have a positive impact in some high-transmission settings, provided that screening is highly specific (to minimize individual harm), at least moderately sensitive (to maximize population benefit), and sufficiently inexpensive (depending on the setting).en_US
dc.description.sponsorshipGE, ACM, TWS, and TAP were supported by grant P01AI098670 (TWS, PI) from the National Institutes of Health, National Institute for Allergy and Infectious Disease.en_US
dc.description.urihttps://doi.org/10.1371/journal.pntd.0007482en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.ispartofPLoS neglected tropical diseasesen_US
dc.subject.meshComputer Simulationen_US
dc.subject.meshDengue Vaccineen_US
dc.subject.meshDengue Virusen_US
dc.subject.meshPublic Health--economicsen_US
dc.titleModel-based assessment of public health impact and cost-effectiveness of dengue vaccination following screening for prior exposureen_US
dc.typeArticleen_US
dc.identifier.doi10.1371/journal.pntd.0007482
dc.identifier.pmid31260441
dc.relation.volume13


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