Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting

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• 作者：Sarah M. Bartsch^a ; ^b ; Peter J. Hotez^c ; ^d ; Daniel L. Hertenstein^a ; ^b ; David J. Diemert^d ; ^e ; Kristina M. Zapf^a ; ^b ; Maria Elena Bottazzi^c ; ^d ; Jeffrey M. Bethony^d ; ^e ; Shawn T. Brown^f ; Bruce Y. Lee^a ; ^b ; ^{brucelee@jhu.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hookworm ; Transmission ; Vaccine ; Drug treatment ; Economics ; Cost
• 刊名：Vaccine
• 出版年：2016
• 出版时间：27 April 2016
• 年：2016
• 卷：34
• 期：19
• 页码：2197-2206
• 全文大小：1234 K

文摘

Although mass drug administration (MDA) has helped reduce morbidity attributed to soil-transmitted helminth infections in children, its limitations for hookworm infection have motivated the development of a human hookworm vaccine to both improve morbidity control and ultimately help block hookworm transmission leading to elimination. However, the potential economic and epidemiologic impact of a preventive vaccine has not been fully evaluated.

Methods

We developed a dynamic compartment model coupled to a clinical and economics outcomes model representing both the human and hookworm populations in a high transmission region of Brazil. Experiments simulated different implementation scenarios of MDA and vaccination under varying circumstances.

Results

Considering only intervention costs, both annual MDA and vaccination were highly cost-effective (ICERs ≤$790/DALY averted) compared to no intervention, with vaccination resulting in lower incremental cost-effectiveness ratios (ICERs ≤$444/DALY averted). From the societal perspective, vaccination was economically dominant (i.e., less costly and more effective) versus annual MDA in all tested scenarios, except when vaccination was less efficacious (20% efficacy, 5 year duration) and MDA coverage was 75%. Increasing the vaccine's duration of protection and efficacy, and including a booster injection in adulthood all increased the benefits of vaccination (i.e., resulted in lower hookworm prevalence, averted more disability-adjusted life years, and saved more costs). Assuming its target product profile, a pediatric hookworm vaccine drastically decreased hookworm prevalence in children to 14.6% after 20 years, compared to 57.2% with no intervention and 54.1% with MDA. The addition of a booster in adulthood further reduced the overall prevalence from 68.0% to 36.0% and nearly eliminated hookworm infection in children.

Conclusion

Using a human hookworm vaccine would be cost-effective and in many cases economically dominant, providing both health benefits and cost-savings. It could become a key technology in effecting control and elimination efforts for hookworm globally.