The global impact and cost-effectiveness of a melioidosis vaccine

Nantasit Luangasanatip, Stefan Flasche, David A.B. Dance, Direk Limmathurotsakul, Bart J. Currie, Chiranjay Mukhopadhyay, Tim Atkins, Richard Titball, Mark Jit

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number129
JournalBMC Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - 05-07-2019

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Melioidosis
Cost-Benefit Analysis
Vaccines
Costs and Cost Analysis
Vaccination
Quality-Adjusted Life Years
Chronic Renal Insufficiency
Decision Trees
Insurance Benefits
Uncertainty
Observational Studies
Health

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Luangasanatip, N., Flasche, S., Dance, D. A. B., Limmathurotsakul, D., Currie, B. J., Mukhopadhyay, C., ... Jit, M. (2019). The global impact and cost-effectiveness of a melioidosis vaccine. BMC Medicine, 17(1), [129]. https://doi.org/10.1186/s12916-019-1358-x
Luangasanatip, Nantasit ; Flasche, Stefan ; Dance, David A.B. ; Limmathurotsakul, Direk ; Currie, Bart J. ; Mukhopadhyay, Chiranjay ; Atkins, Tim ; Titball, Richard ; Jit, Mark. / The global impact and cost-effectiveness of a melioidosis vaccine. In: BMC Medicine. 2019 ; Vol. 17, No. 1.
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Luangasanatip, N, Flasche, S, Dance, DAB, Limmathurotsakul, D, Currie, BJ, Mukhopadhyay, C, Atkins, T, Titball, R & Jit, M 2019, 'The global impact and cost-effectiveness of a melioidosis vaccine', BMC Medicine, vol. 17, no. 1, 129. https://doi.org/10.1186/s12916-019-1358-x

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.

In: BMC Medicine, Vol. 17, No. 1, 129, 05.07.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The global impact and cost-effectiveness of a melioidosis vaccine

AU - Luangasanatip, Nantasit

AU - Flasche, Stefan

AU - Dance, David A.B.

AU - Limmathurotsakul, Direk

AU - Currie, Bart J.

AU - Mukhopadhyay, Chiranjay

AU - Atkins, Tim

AU - Titball, Richard

AU - Jit, Mark

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N2 - 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.

AB - 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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Luangasanatip N, Flasche S, Dance DAB, Limmathurotsakul D, Currie BJ, Mukhopadhyay C et al. The global impact and cost-effectiveness of a melioidosis vaccine. BMC Medicine. 2019 Jul 5;17(1). 129. https://doi.org/10.1186/s12916-019-1358-x