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Title: The global impact and cost-effectiveness of a melioidosis vaccine
Authors: Nantasit Luangasanatip
Stefan Flasche
David A.B. Dance
Direk Limmathurotsakul
Bart J. Currie
Chiranjay Mukhopadhyay
Tim Atkins
Richard Titball
Mark Jit
London School of Hygiene & Tropical Medicine
University of Exeter
Defence Science and Technology Laboratory
Menzies School of Health Research
Kasturba Medical College, Manipal
Mahidol University
Nuffield Department of Clinical Medicine
Royal Darwin Hospital
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)
Keywords: Medicine
Issue Date: 5-Jul-2019
Citation: BMC Medicine. Vol.17, No.1 (2019)
Abstract: © 2019 The Author(s). 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.
ISSN: 17417015
Appears in Collections:Scopus 2019

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