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Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore

Author

Listed:
  • Luis R Carrasco
  • Linda K Lee
  • Vernon J Lee
  • Eng Eong Ooi
  • Donald S Shepard
  • Tun L Thein
  • Victor Gan
  • Alex R Cook
  • David Lye
  • Lee Ching Ng
  • Yee Sin Leo

Abstract

Background: Dengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. Methods and Findings: We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. Conclusions: Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially. Author Summary: Dengue illness is a tropical disease transmitted by mosquitoes that threatens more than one third of the worldwide population. Dengue has important economic consequences because of the burden to hospitals, work absenteeism and risk of death of symptomatic cases. Governments attempt to reduce the disease burden using costly mosquito control strategies such as habitat reduction and spraying insecticide. Despite such efforts, the number of cases remains high. Dengue vaccines are expected to be available in the near future and there is an urgent need to evaluate their cost-effectiveness, i.e. whether their cost will be justified by the reduction in disease burden they bring. For such an evaluation, we estimated the economic impacts of dengue in Singapore and the expected vaccine costs for different prices. In this way we estimated price thresholds for which vaccination is not cost-effective. This research provides useful estimates that will contribute to informed decisions regarding the adoption of dengue vaccination programs.

Suggested Citation

  • Luis R Carrasco & Linda K Lee & Vernon J Lee & Eng Eong Ooi & Donald S Shepard & Tun L Thein & Victor Gan & Alex R Cook & David Lye & Lee Ching Ng & Yee Sin Leo, 2011. "Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 5(12), pages 1-9, December.
  • Handle: RePEc:plo:pntd00:0001426
    DOI: 10.1371/journal.pntd.0001426
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    References listed on IDEAS

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    1. Katherine Standish & Guillermina Kuan & William Avilés & Angel Balmaseda & Eva Harris, 2010. "High Dengue Case Capture Rate in Four Years of a Cohort Study in Nicaragua Compared to National Surveillance Data," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 4(3), pages 1-5, March.
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    Cited by:

    1. Le T P Nghiem & Tarek Soliman & Darren C J Yeo & Hugh T W Tan & Theodore A Evans & John D Mumford & Reuben P Keller & Richard H A Baker & Richard T Corlett & Luis R Carrasco, 2013. "Economic and Environmental Impacts of Harmful Non-Indigenous Species in Southeast Asia," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
    2. Eduardo A Undurraga & Yara A Halasa & Donald S Shepard, 2013. "Use of Expansion Factors to Estimate the Burden of Dengue in Southeast Asia: A Systematic Analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(2), pages 1-15, February.
    3. Christopher Fitzpatrick & Alexander Haines & Mathieu Bangert & Andrew Farlow & Janet Hemingway & Raman Velayudhan, 2017. "An economic evaluation of vector control in the age of a dengue vaccine," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(8), pages 1-27, August.
    4. Donald S Shepard & Eduardo A Undurraga & Yara A Halasa, 2013. "Economic and Disease Burden of Dengue in Southeast Asia," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(2), pages 1-12, February.

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