Comparative economic analysis of strategies for Japanese encephalitis vaccination of U.S. travelers.

Autor: Carias C; Division of Preparedness and Emerging Infections, Emergency Preparedness and Response Branch, Centers for Disease Control and Prevention, 1600 Clifton Road MS H24-11, Atlanta, GA 30329, United States., Hills SL; Division of Vector-Borne Diseases, Arboviral Diseases Branch, Centers for Disease Control and Prevention, 3156 Rampart Rd, Fort Collins, CO 80521, United States. Electronic address: shills@cdc.gov., Kahn EB; Division of Preparedness and Emerging Infections, Emergency Preparedness and Response Branch, Centers for Disease Control and Prevention, 1600 Clifton Road MS H24-11, Atlanta, GA 30329, United States., Adhikari BB; Division of Preparedness and Emerging Infections, Emergency Preparedness and Response Branch, Centers for Disease Control and Prevention, 1600 Clifton Road MS H24-11, Atlanta, GA 30329, United States., Fischer M; Division of Vector-Borne Diseases, Arboviral Diseases Branch, Centers for Disease Control and Prevention, 3156 Rampart Rd, Fort Collins, CO 80521, United States., Meltzer MI; Division of Preparedness and Emerging Infections, Emergency Preparedness and Response Branch, Centers for Disease Control and Prevention, 1600 Clifton Road MS H24-11, Atlanta, GA 30329, United States.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2020 Apr 09; Vol. 38 (17), pp. 3351-3357. Date of Electronic Publication: 2020 Mar 10.
DOI: 10.1016/j.vaccine.2020.02.032
Abstrakt: Background: Japanese encephalitis (JE) virus is the leading vaccine-preventable cause of encephalitis in Asia. For most travelers, JE risk is very low but varies based on several factors, including travel duration, location, and activities. To aid public health officials, health care providers, and travelers evaluate the worth of administering/ receiving pre-travel JE vaccinations, we estimated the numbers-needed-to-treat to prevent a case and the cost-effectiveness ratios of JE vaccination for U.S. travelers in different risk categories.
Methods: We used a decision tree model to estimate cost per case averted from a societal and traveler perspective for hypothetical cohorts of vaccinated and unvaccinated travelers. Risk Category I included travelers planning to spend ≥1 month in JE-endemic areas, Risk Category II were shorter-term (<1 month) travelers spending ≥20% of their time doing outdoor activities in rural areas, and Risk Category III were all remaining travelers. We performed sensitivity analyses including examining changes in cost-effectiveness with 10- and 100-fold increases in incidence and medical treatment costs.
Results: The numbers-needed-to-treat to prevent a case and cost per case averted were approximately 0.7 million and $0.6 billion for Risk Category I, 1.6 million and $1.2 billion for Risk Category II, and 9.8 million and $7.6 billion for Risk Category III. Increases of 10-fold and 100-fold in disease incidence proportionately decreased cost-effectiveness ratios. Similar levels of increases in medical treatment costs resulted in negligible changes in cost-effectiveness ratios.
Conclusion: Numbers-needed-to-treat and cost-effectiveness ratios associated with preventing JE cases in U.S. travelers by vaccination varied greatly by risk category and disease incidence. While cost effectiveness ratios are not the sole rationale for decision-making regarding JE vaccination, the results presented here can aid in making such decisions under very different risk and cost scenarios.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Published by Elsevier Ltd.)
Databáze: MEDLINE
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