TY - JOUR
T1 - The potential economic value of a therapeutic Chagas disease vaccine for pregnant women to prevent congenital transmission
AU - Bartsch, Sarah
AU - Stokes-Cawley, Owen J.
AU - Buekens, Pierre
AU - Asti, Lindsey
AU - Bottazzi, Maria Elena
AU - Strych, Ulrich
AU - Wedlock, Patrick T
AU - Mitgang, Elizabeth A.
AU - Meymandi, Sheba
AU - Falcon-Lezama, Jorge Abelardo
AU - Hotez, Peter J.
AU - Lee, Bruce Y.
N1 - Funding Information:
This work was supported by the Carlos Slim Foundation, the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS023317 , the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) via grant U01HD086861 and R01HD086013 , the NICHD and Office of Behavioral and Social Sciences Research (OBSSR) under award number U54HD070725 , and the United States Agency for International Development (USAID) under agreement number AID- OAA-A-15-0064 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review or approval of the manuscript.
Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/4/3
Y1 - 2020/4/3
N2 - Background: Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1–40% of pregnant women in Latin America and is associated with a 5% transmission risk. With therapeutic vaccines under development, now is the right time to determine the economic value of such a vaccine to prevent congenital transmission. Methods: We developed a computational decision model that represented the clinical outcomes and diagnostic testing strategies for an infant born to a Chagas-positive woman in Mexico and evaluated the impact of vaccination. Results: Compared to no vaccination, a 25% efficacious vaccine averted 125 [95% uncertainty interval (UI): 122–128] congenital cases, 1.9 (95% UI: 1.6–2.2) infant deaths, and 78 (95% UI: 66–91) DALYs per 10,000 infected pregnant women; a 50% efficacious vaccine averted 251 (95% UI: 248–254) cases, 3.8 (95% UI: 3.6–4.2) deaths, and 160 (95% UI: 148–171) DALYs; and a 75% efficacious vaccine averted 376 (95% UI: 374–378) cases, 5.8 (95% UI: 5.5–6.1) deaths, and 238 (95% UI: 227–249) DALYs. A 25% efficacious vaccine was cost-effective (incremental cost-effectiveness ratio <3× Mexico's gross domestic product per capita, <$29,698/DALY averted) when the vaccine cost ≤$240 and ≤$310 and cost-saving when ≤$10 and ≤$80 from the third-party payer and societal perspectives, respectively. A 50% efficacious vaccine was cost-effective when costing ≤$490 and ≤$615 and cost-saving when ≤$25 and ≤$160, from the third-party payer and societal perspectives, respectively. A 75% efficacious vaccine was cost-effective when ≤$720 and ≤$930 and cost-saving when ≤$40 and ≤$250 from the third-party payer and societal perspectives, respectively. Additionally, 13–42 fewer infants progressed to chronic disease, saving $0.41-$1.21 million to society. Conclusion: We delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
AB - Background: Currently, there are no solutions to prevent congenital transmission of Chagas disease during pregnancy, which affects 1–40% of pregnant women in Latin America and is associated with a 5% transmission risk. With therapeutic vaccines under development, now is the right time to determine the economic value of such a vaccine to prevent congenital transmission. Methods: We developed a computational decision model that represented the clinical outcomes and diagnostic testing strategies for an infant born to a Chagas-positive woman in Mexico and evaluated the impact of vaccination. Results: Compared to no vaccination, a 25% efficacious vaccine averted 125 [95% uncertainty interval (UI): 122–128] congenital cases, 1.9 (95% UI: 1.6–2.2) infant deaths, and 78 (95% UI: 66–91) DALYs per 10,000 infected pregnant women; a 50% efficacious vaccine averted 251 (95% UI: 248–254) cases, 3.8 (95% UI: 3.6–4.2) deaths, and 160 (95% UI: 148–171) DALYs; and a 75% efficacious vaccine averted 376 (95% UI: 374–378) cases, 5.8 (95% UI: 5.5–6.1) deaths, and 238 (95% UI: 227–249) DALYs. A 25% efficacious vaccine was cost-effective (incremental cost-effectiveness ratio <3× Mexico's gross domestic product per capita, <$29,698/DALY averted) when the vaccine cost ≤$240 and ≤$310 and cost-saving when ≤$10 and ≤$80 from the third-party payer and societal perspectives, respectively. A 50% efficacious vaccine was cost-effective when costing ≤$490 and ≤$615 and cost-saving when ≤$25 and ≤$160, from the third-party payer and societal perspectives, respectively. A 75% efficacious vaccine was cost-effective when ≤$720 and ≤$930 and cost-saving when ≤$40 and ≤$250 from the third-party payer and societal perspectives, respectively. Additionally, 13–42 fewer infants progressed to chronic disease, saving $0.41-$1.21 million to society. Conclusion: We delineated the thresholds at which therapeutic vaccination of Chagas-positive pregnant women would be cost-effective and cost-saving, providing economic guidance for decision-makers to consider when developing and bringing such a vaccine to market.
KW - Chagas disease
KW - Congenital transmission
KW - Economics
KW - Pregnancy
KW - Vaccine
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U2 - 10.1016/j.vaccine.2020.02.078
DO - 10.1016/j.vaccine.2020.02.078
M3 - Article
C2 - 32171575
AN - SCOPUS:85081914261
SN - 0264-410X
VL - 38
SP - 3261
EP - 3270
JO - Vaccine
JF - Vaccine
IS - 16
ER -