SCHOOL OF PHARMACEUTICAL SCIENCES SCHOOL OF PHARMACEUTICAL SCIENCES International Fellow, International Society for Pharmacoeconomics & Outcomes Research Program Chairman, Universiti Sains Malaysia COST-EFFECTIVE PRICE OF DENGUE VACCINATION IN MALAYSIA Assoc Prof Dr Asrul Akmal Shafie [email protected]
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SCHOOL OF PHARMACEUTICAL SCIENCES
SCHOOL OF PHARMACEUTICAL SCIENCES
International Fellow,
International Society for Pharmacoeconomics &
Outcomes Research
Program Chairman,
Universiti Sains Malaysia
COST-EFFECTIVE PRICE OF DENGUE VACCINATION IN MALAYSIA
1. Suaya, J. A., et al. (2009). "Cost of dengue cases in eight countries in the Americas and Asia: a prospective study." Am J Trop Med Hyg 80(5): 846-855.
2. Shepard, D. S., et al. (2012). "Use of multiple data sources to estimate the economic cost of dengue illness in Malaysia." Am J Trop Med Hyg 87(5): 796-805.
SCHOOL OF PHARMACEUTICAL SCIENCES
How to Determine the CE Value of Dengue Vaccine?
= + Avoidance of Productivity Losses +
Loss of school day Loss of work productivity
Ambulatory
Mean±SD loss of school day: 3.2±2.3 days
Hospitalized
Mean±SD loss of school day: 4.1±2.1 days
Ambulatory
Mean±SD loss of work productivity: 7.2±2.6 days
Hospitalized
Mean±SD loss of work productivity: 8.8±2.7 days
Suaya, J. A., et al. (2009). Am J Trop Med Hyg 80(5): 846-855.
SCHOOL OF PHARMACEUTICAL SCIENCES
Societal Perspective
CRITERIA ITEM VALUATION PUBLISHED COST
(US$)
COST PER CASE 2013
(US$)
Dengue
Treatment
Ambulatory/ Indirect Minimum wages or cost/
school day 176.36 (2009) 193.28
Hospitalized/ Indirect Minimum wages or cost/
school day 200.55 (2009) 219.79
How to Determine the CE Price of Dengue Vaccine?
= + Avoidance of productivity losses to receive treatment
SCHOOL OF PHARMACEUTICAL SCIENCES
Public Provider & Societal Perspective
CRITERIA ITEM VALUATION SOURCE /
REFERENCE
COST 2013
PER DOSE
(US$)
PUBLIC
PROVIDER
COST PER
DOSE (US$)
SOCIETAL
COST PER
DOSE
(US$)
Dengue
Vaccination
Program
Ad
min
istr
atio
n
Personnel MOH salary scale Ministry of Health
Clinician’s opinion
3.58 3.58
(Provider) 5.96
(Societal)
Equipment &
consumable
items
MOH price list
Treatment of
adverse events
Average cost in
Malaysia public
healthcare center
Clinician’s opinion
WHO-CHOICE
Indirect
Weighted
minimum wages
and cost per
school day
Ministry of
Human Resource
Malaysia
Suaya 2009
2.38 -
How to Determine the CE Price of Dengue Vaccine?
= - cost of Administering Vaccine
SCHOOL OF PHARMACEUTICAL SCIENCES
Using Dynamic Transmission Model to Determine the ∆
1. Coudeville L, Garnett G [2012] PloS One
2. Amaku M, Coudeville L, Massad E [2012] Rev. Inst. Med. trop. S. Paulo
Key features
Compartmental model (deterministic)
Host-vector interactions
Interaction between the 4 serotypes
Age-specific level of incidence & disease transmission
Host and vector population growth
Seasonality
Serotype-specific impact of vaccination
Vaccinated
Flow diagram
- 4 serotypes -
Vectors
Incub1
Susceptible
Infec1
Infec2
Infec3
Infec4
Incub2
Incub3
Incub4
Vectors
Incub1
Susceptible
Infec1
Infec2
Infec3
Infec4
Incub2
Incub3
Incub4
VaccinatedSusceptible
Short-termimmunity
Long-term immunity
Hosts – Dengue 2
Latent infection
Dengue Fever
DHF/DSSAsymptomatic
InfectionDengue Fever
DHF/DSSAsymptomatic
Infection
VaccinatedSusceptible
Latent infection
Short-termimmunity
Long-termimmunity
Hosts – Dengue 1
Dengue Fever
DHF/DSSAsymptomatic
InfectionDengue Fever
DHF/DSSAsymptomatic
Infection
Susceptible
Short-term immunity
Long-termimmunity
Hosts – Dengue 3
Dengue Fever
DHF/DSSAsymptomatic
InfectionDengue Fever
DHF/DSSAsymptomatic
Infection
Latent infection
VaccinatedSusceptible
Short-termimmunity
Long-termimmunity
Hosts – Dengue 4
Dengue Fever
DHF/DSSAsymptomatic
InfectionDengue Fever
DHF/DSSAsymptomatic
Infection
Latent infection
SCHOOL OF PHARMACEUTICAL SCIENCES
WHAT IS THE ECONOMIC IMPACT & COST-EFFECTIVE PRICE OF DENGUE VACCINE IN
MALAYSIA?
R13C30
SCHOOL OF PHARMACEUTICAL SCIENCES
Evaluated Strategies
NATIONWIDE HOTSPOT
Strategy R9C17 R9C30 R13C30 R9C17 R9C30 R13C30
Compliance 95% 66%
60%
95% 64%
59%
N 8,429,404 12,572,912
10,619,309
1,531,057
2,283,654
1,928,816
*Hotspots: Kuala Lumpur, Petaling, Putrajaya, Klang, Hulu Langat & Gombak
**Catchup within 1 year
SCHOOL OF PHARMACEUTICAL SCIENCES
Simulation Parameters
Simulation Parameters Values
Reporting factors – Hospitalized2 1.7
Reporting factors – Ambulatory2 3.79
Vaccine Wastage1 20%
Discount Rate3 3%
Vaccine Protection4 10 years
GDP/capita 2013 (IMF 2014) 10456.89 $
1. Ministry of Health Malaysia key personnel expert opinion.
2. Shepard, D.S., et al. [2012] Am J Trop Med Hyg, 87(5): p. 796-805.
3. Malaysia Pharmacoeconomics Guidelines.
4. Assumptions.
SCHOOL OF PHARMACEUTICAL SCIENCES
THS R13C30 Health Impact
No Vaccination
Vaccination
Dengue cases
904,259
450,983
No Vaccine
With Vaccine
50% (95%CI 33-65%)
Dengue deaths
52% (95%CI 35-68%)
No Vaccine
With Vaccine
973
464
Disability-Adjusted-Life-Year (DALY) 32,387.5
15,528
No Vaccine
With Vaccine
No Vaccination
With Vaccination
52% (95%CI 35-67%)
53% (95%CI 36-68%)
Life Year Lost
No Vaccine
With Vaccine
10,551
22,377.5
SCHOOL OF PHARMACEUTICAL SCIENCES
Summary : Economic Impact
Disease Cost With Vaccine (Provider)
324.98
664.06
158.04
334.59
291.19
598.11
141.67
300.61 370.90
756.96
176.17
374.87
0
100
200
300
400
500
600
700
800
Targeted Hotspot R13C30 Nationwide R13C30
US$
M
ILLI
ON
S
Disease Cost With Vaccine (Societal) Productivity Loss With Vaccine
Disease Cost Without Vaccine (Provider) Disease Cost Without Vaccine (Societal) Productivity Loss Without Vaccine
• Dengue vaccination in Malaysia reduces the dengue related health and economic burden ranging from 41-56% for different strategies.
• A vaccination program would be highly cost-effective at a price below US$46 from the provider perspective in the targeted hotspot R13C30 scenario.
• The presence of assumptions and uncertainties in key parameters, but have been assessed through DSA and PSA
• Burden of dengue disease in this study only captures dengue treatment. Other factors such as dengue related deaths, long-term sequelae of dengue disease, vector prevention & control, surveillance, loss in tourism and loss in foreign investment were not included.
SCHOOL OF PHARMACEUTICAL SCIENCES
THANK YOU
Acknowledgement and appreciation to:
• Ms Yeo Hui Yee, MSc Candidate
• Sanofi for the research grant.
• Laurent Coudeville, Lucas Steinberg, Sanofi Pasteur
• Dr Balvinder, Dr Amar, Dr Rohani, MoH Malaysia
• Shafie AA, Yeo HY, Coudeville L, Gill BS, Steinberg L. A dynamic transmission model