COST-EFFECTIVENESS ANALYSIS OF DENGUE VACCINATION IN BANGLADESH
Author(s)
Sayem Ahmed, PhD1, Amrit Banstola, MSc1, Quazi Nazmus Sakib, MSc2, Mohammad Wahid Ahmed, MSc3, Jahangir Khan, PhD4.
1Brunel University London, London, United Kingdom, 2University of Algoma, Algoma, ON, Canada, 3icddr,b, Dhaka, Bangladesh, 4University, Gothenburg, Sweden.
1Brunel University London, London, United Kingdom, 2University of Algoma, Algoma, ON, Canada, 3icddr,b, Dhaka, Bangladesh, 4University, Gothenburg, Sweden.
OBJECTIVES: Bangladesh has experienced a rapidly increasing dengue burden in recent years. Clinical trials of several dengue vaccines conducted across multiple countries have demonstrated efficacy in reducing dengue disease burden. Despite Bangladesh’s well-established national immunization infrastructure, dengue vaccination has not yet been incorporated into routine programs. Given competing health priorities and resource constraints, robust economic evaluation is essential prior to adoption. This study evaluates the cost-effectiveness of two tetravalent dengue vaccines, Dengvaxia and Qdenga, each compared against no vaccination, from a societal perspective.
METHODS: We used a static cohort model (decision tree combined with Markov model) to evaluate dengue disease in a cohort of 10-year-old individuals in Bangladesh. We compared Dengvaxia under a pre-vaccination serological screening strategy and Qdenga under universal vaccination and no-vaccination strategies. Outcomes included disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratios were estimated. All costs are expressed in 2024 US dollars and discounted at 3%. Uncertainty was assessed using one-way deterministic and probabilistic sensitivity analyses, and scenario analyses were conducted for vaccine prices.
RESULTS: In the base case, both vaccination strategies were below the 3× GDP per capita threshold but above the 1× threshold. The ICER was $3,206 per DALY averted for Qdenga and $6,532 for Dengvaxia. Implementation of Qdenga required approximately US$347 million, yielding 108,000 DALYs averted, compared with US$153 million and 23,000 DALYs averted for Dengvaxia. PSA showed that at the 3× GDP threshold, the probability of cost-effectiveness was 94% for Qdenga and 64% for Dengvaxia. One-way sensitivity analysis identified dengue incidence, vaccine price, and disability weights as the primary drivers of ICER variation.
CONCLUSIONS: Dengue vaccination in Bangladesh is cost-effective versus no vaccination at a 3× GDP threshold only under low vaccine price conditions, with Qdenga consistently more cost-effective than Dengvaxia.
METHODS: We used a static cohort model (decision tree combined with Markov model) to evaluate dengue disease in a cohort of 10-year-old individuals in Bangladesh. We compared Dengvaxia under a pre-vaccination serological screening strategy and Qdenga under universal vaccination and no-vaccination strategies. Outcomes included disability-adjusted life-years (DALYs), and incremental cost-effectiveness ratios were estimated. All costs are expressed in 2024 US dollars and discounted at 3%. Uncertainty was assessed using one-way deterministic and probabilistic sensitivity analyses, and scenario analyses were conducted for vaccine prices.
RESULTS: In the base case, both vaccination strategies were below the 3× GDP per capita threshold but above the 1× threshold. The ICER was $3,206 per DALY averted for Qdenga and $6,532 for Dengvaxia. Implementation of Qdenga required approximately US$347 million, yielding 108,000 DALYs averted, compared with US$153 million and 23,000 DALYs averted for Dengvaxia. PSA showed that at the 3× GDP threshold, the probability of cost-effectiveness was 94% for Qdenga and 64% for Dengvaxia. One-way sensitivity analysis identified dengue incidence, vaccine price, and disability weights as the primary drivers of ICER variation.
CONCLUSIONS: Dengue vaccination in Bangladesh is cost-effective versus no vaccination at a 3× GDP threshold only under low vaccine price conditions, with Qdenga consistently more cost-effective than Dengvaxia.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE755
Topic
Economic Evaluation
Disease
Vaccines