TY - JOUR
T1 - What Is the Value of Different Zika Vaccination Strategies to Prevent and Mitigate Zika Outbreaks?
AU - Bartsch, Sarah M.
AU - Asti, Lindsey
AU - Cox, Sarah N.
AU - Durham, David P.
AU - Randall, Samuel
AU - Hotez, Peter J.
AU - Galvani, Alison P.
AU - Lee, Bruce Y.
N1 - Funding Information:
Financial support. This work was supported by the Bill & Melinda Gates Foundation (Award Number OPP1139051); Instituto Carlos Slim de la Salud; the National Institutes of Health (grant numbers U01 GM087719, U01 GM105627, U54HD070725, U01 HD086861); the Agency for Healthcare Research and Quality (grant number R01HS023317); and the US Agency for International Development (grant number AID-OAA-A-15-00064). Potential conflicts of interest. All authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Publisher Copyright:
© 2018 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2019/8/9
Y1 - 2019/8/9
N2 - Background: While the 2015-2016 Zika epidemics prompted accelerated vaccine development, decision makers need to know the potential economic value of vaccination strategies. Methods: We developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination (women of childbearing age, school-aged children, young adults, and everyone) and then introduced various Zika outbreaks. Sensitivity analyses varied vaccine characteristics. Results: With a 2% attack rate ($5 vaccination), compared to no vaccination, vaccinating women of childbearing age cost $314-$1664 per case averted ($790-$4221/disability-adjusted life-year [DALY] averted) in Honduras, and saved $847-$1644/case averted in Brazil, and $3648-$4177/case averted in Puerto Rico, varying with vaccination coverage and efficacy (societal perspective). Vaccinating school-aged children cost $718-$1849/case averted (≤$5002/DALY averted) in Honduras, saved $819-$1609/case averted in Brazil, and saved $3823-$4360/case averted in Puerto Rico. Vaccinating young adults cost $310-$1666/case averted ($731-$4017/DALY averted) in Honduras, saved $953-$1703/case averted in Brazil, and saved $3857-$4372/case averted in Puerto Rico. Vaccinating everyone averted more cases but cost more, decreasing cost savings per case averted. Vaccination resulted in more cost savings and better outcomes at higher attack rates. Conclusions: When considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
AB - Background: While the 2015-2016 Zika epidemics prompted accelerated vaccine development, decision makers need to know the potential economic value of vaccination strategies. Methods: We developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination (women of childbearing age, school-aged children, young adults, and everyone) and then introduced various Zika outbreaks. Sensitivity analyses varied vaccine characteristics. Results: With a 2% attack rate ($5 vaccination), compared to no vaccination, vaccinating women of childbearing age cost $314-$1664 per case averted ($790-$4221/disability-adjusted life-year [DALY] averted) in Honduras, and saved $847-$1644/case averted in Brazil, and $3648-$4177/case averted in Puerto Rico, varying with vaccination coverage and efficacy (societal perspective). Vaccinating school-aged children cost $718-$1849/case averted (≤$5002/DALY averted) in Honduras, saved $819-$1609/case averted in Brazil, and saved $3823-$4360/case averted in Puerto Rico. Vaccinating young adults cost $310-$1666/case averted ($731-$4017/DALY averted) in Honduras, saved $953-$1703/case averted in Brazil, and saved $3857-$4372/case averted in Puerto Rico. Vaccinating everyone averted more cases but cost more, decreasing cost savings per case averted. Vaccination resulted in more cost savings and better outcomes at higher attack rates. Conclusions: When considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
KW - Zika
KW - cost-effectiveness
KW - vaccine
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U2 - 10.1093/infdis/jiy688
DO - 10.1093/infdis/jiy688
M3 - Article
C2 - 30544164
AN - SCOPUS:85071348874
SN - 0022-1899
VL - 220
SP - 920
EP - 931
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 6
ER -