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The global impact and cost-effectiveness of a melioidosis vaccine.
Luangasanatip, Nantasit; Flasche, Stefan; Dance, David A B; Limmathurotsakul, Direk; Currie, Bart J; Mukhopadhyay, Chiranjay; Atkins, Tim; Titball, Richard; Jit, Mark.
Afiliación
  • Luangasanatip N; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. nantasit@tropmedres.ac.
  • Flasche S; College of Life and Environmental Sciences, University of Exeter, Exeter, UK. nantasit@tropmedres.ac.
  • Dance DAB; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. nantasit@tropmedres.ac.
  • Limmathurotsakul D; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Currie BJ; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic.
  • Mukhopadhyay C; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
  • Atkins T; Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
  • Titball R; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Jit M; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
BMC Med ; 17(1): 129, 2019 07 05.
Article en En | MEDLINE | ID: mdl-31272431
ABSTRACT

BACKGROUND:

Every year, 90,000 people may die from melioidosis. Vaccine candidates have not proceeded past animal studies, partly due to uncertainty around the potential market size. This study aims to estimate the potential impact, cost-effectiveness and market size for melioidosis vaccines.

METHODS:

Age-structured decision tree models with country-specific inputs were used to estimate net costs and health benefits of vaccination, with health measured in quality-adjusted life years (QALYs). Four target groups of people living in endemic regions were considered (i) people aged over 45 years with chronic renal disease, (ii) people aged over 45 years with diabetes, (iii) people aged over 45 years with diabetes and/or chronic renal disease, (iv) everyone aged over 45 years. Melioidosis risk was estimated using Bayesian evidence synthesis of 12 observational studies. In the base case, vaccines were assumed to have 80% efficacy, to have 5-year mean protective duration and to cost USD10.20-338.20 per vaccine.

RESULTS:

Vaccination could be cost-effective (with incremental cost-effectiveness ratio below GDP per capita) in 61/83 countries/territories with local melioidosis transmission. In these 61 countries/territories, vaccination could avert 68,000 lost QALYs, 8300 cases and 4400 deaths per vaccinated age cohort, at an incremental cost of USD59.6 million. Strategy (ii) was optimal in most regions. The vaccine market may be worth USD268 million per year at its threshold cost-effective price in each country/territory.

CONCLUSIONS:

There is a viable melioidosis vaccine market, with cost-effective vaccine strategies in most countries/territories with local transmission.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Vacunación / Melioidosis Tipo de estudio: Health_economic_evaluation / Observational_studies / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: BMC Med Asunto de la revista: MEDICINA Año: 2019 Tipo del documento: Article País de afiliación: Reino Unido

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Vacunación / Melioidosis Tipo de estudio: Health_economic_evaluation / Observational_studies / Prognostic_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: BMC Med Asunto de la revista: MEDICINA Año: 2019 Tipo del documento: Article País de afiliación: Reino Unido