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      Projected costs associated with school-based screening to inform deployment of Dengvaxia: Vietnam as a case study

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          Abstract

          Background

          After new analysis, Sanofi Pasteur now recommends their dengue vaccine (Dengvaxia) should only be given to individuals previously infected with dengue and the World Health Organization’s recommendations regarding its use are currently being revised. As a result, the potential costs of performing large-scale individual dengue screening and/or dengue serosurveys have become an important consideration for decision making by policymakers in dengue-endemic areas.

          Methods

          We used an ingredients-based approach to estimate the financial costs for conducting both a school-based dengue serosurvey and school-based individual dengue screening within a typical province in Vietnam, using an existing commercial indirect immunoglobulin G enzyme-linked immunosorbent assay kit. This costing is hypothetical and based on estimates regarding the resources that would be required to perform such activities.

          Results

          We estimated that performing a school-based individual screening of 9-year-olds would cost US$9.25 per child tested or US$197,827 in total for a typical province. We also estimated that a school-based serosurvey would cost US$10,074, assuming one class from each of the grades that include 8- to 11-year-olds are sampled at each of the 12 selected schools across the province.

          Conclusions

          The study indicates that using this vaccine safely on a large-scale will incur noteworthy operational costs. It is crucial that these be considered in future cost-effectiveness analyses informing how and where the vaccine is deployed.

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          Most cited references20

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          Efficacy and Long-Term Safety of a Dengue Vaccine in Regions of Endemic Disease.

          A candidate tetravalent dengue vaccine is being assessed in three clinical trials involving more than 35,000 children between the ages of 2 and 16 years in Asian-Pacific and Latin American countries. We report the results of long-term follow-up interim analyses and integrated efficacy analyses.
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            Benefits and risks of the Sanofi-Pasteur dengue vaccine: Modeling optimal deployment.

            The first approved dengue vaccine has now been licensed in six countries. We propose that this live attenuated vaccine acts like a silent natural infection in priming or boosting host immunity. A transmission dynamic model incorporating this hypothesis fits recent clinical trial data well and predicts that vaccine effectiveness depends strongly on the age group vaccinated and local transmission intensity. Vaccination in low-transmission settings may increase the incidence of more severe "secondary-like" infection and, thus, the numbers hospitalized for dengue. In moderate transmission settings, we predict positive impacts overall but increased risks of hospitalization with dengue disease for individuals who are vaccinated when seronegative. However, in high-transmission settings, vaccination benefits both the whole population and seronegative recipients. Our analysis can help inform policy-makers evaluating this and other candidate dengue vaccines.
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              Allowing for differential timing in cost analyses: discounting and annualization.

              There are differences in timing related to when costs of certain inputs are incurred and when they are used over the lifetime of a programme. This paper looks at the issues related to the comparison of cost data over time focusing on discounting and annualization adjustments, which are used by economists to calculate financial and economic costs. The process of discounting is used to deal with the notion of time preference. Time preference implies that future costs are worth less, and hence discounted more, to reflect individual and societal preferences to have resources and money now rather than in the future. While discounting is appropriate in many situations, it is also useful to compute an annual equivalent cost when recurrent costs of an intervention are incurred, or are expected to be incurred, in subsequent years. This approach has the added benefit of illustrating how capital items are actually used during the lifetime of an intervention. This paper presents methods to both discount and annualize costs, and discusses rules-of-thumb to decide when to make these adjustments.
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                Author and article information

                Journal
                Trans R Soc Trop Med Hyg
                Trans. R. Soc. Trop. Med. Hyg
                trstmh
                Transactions of the Royal Society of Tropical Medicine and Hygiene
                Oxford University Press
                0035-9203
                1878-3503
                August 2018
                03 July 2018
                03 July 2018
                : 112
                : 8
                : 369-377
                Affiliations
                [1 ]Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
                [2 ]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
                [3 ]Pasteur Institute, Ho Chi Minh City, Vietnam
                [4 ]Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, Pennsylvania, USA
                Author notes
                Corresponding author: E-mail: hturner@ 123456oucru.org
                Article
                try057
                10.1093/trstmh/try057
                6092611
                29982700
                759a9124-8939-489a-a4dd-d951b6bcaabc
                © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 March 2018
                : 15 May 2018
                : 02 June 2018
                Page count
                Pages: 9
                Funding
                Funded by: Wellcome Trust 10.13039/100010269
                Award ID: 089276/B/09/7
                Categories
                Original Articles

                Medicine
                cost,dengue,dengvaxia,screening,serosurvey,vaccine
                Medicine
                cost, dengue, dengvaxia, screening, serosurvey, vaccine

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