Prevention and control of dengue and chikungunya in Colombia: A cost-effectiveness analysis


Abstract

Background: Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 -December 2017).

Methodology/principal findings: We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10-19 or 10-29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price.

Conclusions/significance: Insecticide to prevent chikungunya and dengue in Colombia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Schematic of chikungunya and dengue dynamic transmission model.
*Xi = susceptible to disease i (C = chikungunya, D = dengue), Y0i = infected with disease i with no symptoms, Y1i = infected with disease i with symptoms, R0C = recovered from chikungunya with no sequelae, R1C = recovered from chikungunya with sequelae, Vi = vaccinated against disease i.
Fig 2
Fig 2. Expected cumulative incidence by disease and intervention.
Fig 3
Fig 3. Expected cumulative deaths by disease and intervention.
Fig 4
Fig 4. Incremental costs, DALYs averted, and incremental cost-effectiveness ratio for strategies on the cost-effectiveness frontier.
LLIN = long-lasting insecticide-treated net.
Fig 5
Fig 5. Incremental costs and DALYs averted for all strategies and all parameter sets.
Fig 6
Fig 6. Sensitivity analysis: Preferred intervention by cost of vaccine when diagnostic test cost is set to $1.
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