Public Health Impact and Cost-Effectiveness of a New Dengue Vaccine (TAK-003) in a Large Catch-up Cohort in Puerto Rico

OBJECTIVES: Dengue causes considerable burden on the population and healthcare system of Puerto Rico (PR). There are no specific treatments available; consequently, vaccination is an important preventive measure to reduce dengue burden. In the pivotal phase 3 trial (DEN-301), the tetravalent vaccine TAK-003 was highly effective at preventing dengue, regardless of serostatus. This study investigated the public health impact and cost-effectiveness of a pediatric TAK-003 vaccination strategy with a large catch-up, compared to no vaccination.

METHODS: A deterministic compartmental dynamic model was developed to model dengue transmissions in both the host and vector populations, accounting for dengue infection history and all four dengue serotypes. Vaccination strategy examined was routine vaccination at age 4 (vaccine label lowest age) with catch-up between ages 5–18 (vaccine coverage assumed at 80%). These cohorts would enable all eligible children to be vaccinated in a programmatic implementation of TAK-003. Vaccine efficacy was derived from the DEN-301 trial and extrapolated over the analysis time horizon. Model inputs were derived from data specific to PR and the model was fitted to PR dengue epidemiology. At an illustrative cost of $154 per dose, cost-effectiveness was estimated from a societal perspective over 20 years (discount rate of 3%) and benefits measured by disability-adjusted life years (DALYs).

RESULTS: Modelling results showed that the explored TAK-003 vaccination strategy of all eligible children was associated with reductions of 34% and 51% for symptomatic and hospitalized cases, respectively, compared to no vaccination. TAK-003 vaccination was found to be dominant over no vaccination, with total costs savings of $408 million and 5,314 DALYs averted.

CONCLUSIONS: A TAK-003 vaccination program in children aged 4–18 years in PR may lead to a significant reduction in dengue cases and would cost less overall compared to no vaccination.