Cost-Effectiveness of a Dengue Vaccine in Southeast Asia and Panama: Preliminary Estimates

  • D. S. Shepard
  • J. A. Suaya


To ascertain the economic feasibility of a pediatric tetravalent dengue vaccine, we developed and calibrated a cost-effectiveness model of vaccinating children at 15 months in Southeast Asia and Panama using a societal perspective. We assumed that full immunization would require two doses. In Southeast Asia, the gross cost per vaccinee would be US $8.28. Due to projected savings in dengue treatment, the net cost per capita would be 89% below the gross cost. The cost per disability adjusted life year (DALY) saved by a pediatric vaccine would be $50, making the potential vaccine highly cost-effective. In Panama, where we assumed a higher price per dose ($5), the gross cost per vaccinee would be $19.70 for infants and $26.70 in a catch up program for adults. As projected treatment costs are higher, however, averaging $154.27 when discounted to the time of vaccination, the estimated cost offsets would be 178% of vaccination costs for infants and 138% for adults. Thus the dengue vaccination appears to be cost saving under our most likely assumptions. Many uncertainties remain, however, until more epidemiological and economic data are obtained and vaccine development proceeds further.


Dengue Fever Dengue Hemorrhagic Fever Dengue Case Vector Control Program Dengue Vaccine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


cost saving


disability adjusted life years


dengue fever


dengue hemorrhagic fever


diphtheria pertussis tetanus (dose 3)


dengue shock syndrome


Global Alliance for Vaccines and Immunization


gross national income


hepatitis B vaccine


hemophilus influenza B


Pan American Health Organization

SE Asia

Southeast Asia


World Health Organization



The preparation of this chapter was supported in part by the endowment of the Schneider Institutes for Health Policy, Brandeis University, Waltham, MA, USA. The authors are indebted to Gladys Guerrero, MD, MPH, and Dennys Rodriguez of the Department of Epidemiological Surveillance of the Panama Ministry of Health for providing epidemiological data from Panama, to Blas Armien, MD, of the Gorgas Memorial Institute, Panama, for assistance with analysis of these data, and to Clare L. Hurley, MM, of Brandeis University for editorial assistance.


  1. Almond J, Clemens J, Engers H, Halstead SB, Khiem HB, Pablos-Mendez A, Pervikov Y, Tram TT. (2002). Vaccine. 20: 3043–3046.PubMedCrossRefGoogle Scholar
  2. Armien B, Suaya J, Quiroz E, Sah B, Bayard V, Marchena L, Campos C, Shepard D. (2008). Am J Trop Med Hyg. 79: 364–371.PubMedGoogle Scholar
  3. BBC. (2007). Dengue sparks Paraguay emergency. London Accessed 2 March 2007.
  4. Centers for Disease Control. (2002). Notice: dengue fever in Hawaii. Accessed 23 January 2002.
  5. Central Intelligence Agency. (2008). Panama. The world factbook. Langley, VA, Central Intelligence Agency. Accessed June 25, 2008.
  6. Global Alliance for Vaccines and Immunizations. (2002). Accessed 29 January 2002.
  7. Gold MR, Siegel JE, Russell LB, Weinstein MC. (1996). Cost-Effectiveness in Health and Medicine. Oxford University Press, New York.Google Scholar
  8. Gubler D, Meltzer M. (1999). Adv Virus Res. 53: 35–70.PubMedCrossRefGoogle Scholar
  9. Gubler DJ. (1998). Clin Microbiol Rev. 11: 480–496.PubMedGoogle Scholar
  10. Institute of Medicine. (1986). New Vaccine Development: Establishing Priorities, vol. II: Diseases of Importance in Developing Countries. National Academy Press, Washington, DC.Google Scholar
  11. Mahoney RT, Maynard JE. (1999). Vaccine. 17: 646–652.PubMedCrossRefGoogle Scholar
  12. Menou V, Hornstein A, Lipton-McCombie E. (2008). Access to medicine index (Report prepared by the Innovest Healthcare Team). Netherlands Access to Medicine Foundation, Haarlem.
  13. Muraskin W. (1995). The War Against Hepatitis B: A History of the International Task Force on Hepatitis B Immunization. University of Pennsylvania Press, Philadelphia.Google Scholar
  14. Nathan MB. (1993). J Am Mosq Control Assoc. 9: 1–7.PubMedGoogle Scholar
  15. Pan American Health Organization (PAHO). (1999). A Blueprint for Action for the Next Generation: Dengue Prevention and Control.–99.doc Accessed 29 January 2002.
  16. Pan American Health Organization. (2008). Dengue: Progress Report. Provisional Agenda Item 4.10, document CE142/17 (Eng.) for 142nd Session of the Executive Committee, Washington, D.C., USA, 23–27 June 2008.Pan American Health Organization, World Health Organization, Washington, DC.$File/full_report.pdf. Accessed 22 May 2008.
  17. Panama Ministry of Health. (2008). Dengue cases by health region and age group, 2005–2007. [Casos de dengue según region de salud por grupo de edad, 2005–2007]. Directorate of General Health, Department of Epidemiology, Panama.Google Scholar
  18. Pediatric Dengue Vaccine Initiative (PDVI). (2008). Dengue vaccines. Pediatric Dengue Vaccine Initiative, Seoul, Korea.
  19. Pegurri E, Fox-Rushby JA, Walker D. (2005). Vaccine. 23:1624–1635.PubMedCrossRefGoogle Scholar
  20. Population Reference Bureau. (2001).–2002/sheet1.html. Accessed 18 August 2002.
  21. Shepard D, Suaya J, Halstead S, Nathan M, Gubler D, Mahoney R, Wang D, Meltzer M. (2004). Vaccine. 22: 1275–1280.PubMedCrossRefGoogle Scholar
  22. Shepard D, Thompson M. (1979). Public Health Rep. 94: 535–543.PubMedGoogle Scholar
  23. Shepard D, Walsh J, Kleinau E, Stansfield S, Bhalotra S. (1995). Vaccine. 13: 707–714.PubMedCrossRefGoogle Scholar
  24. Shepard DS, Halstead SB. (1993). In: Jamison DT, Mosley WH, Measham AR, Bobadilla JL (ed.) Disease Control Priorities in Developing Countries. The World Bank, Oxford University Press, New York, pp. 303–320.Google Scholar
  25. Sinha A, Levine O, Knoll M, Muhib F, Lieu T. (2007). Lancet. 369: 389–396.PubMedCrossRefGoogle Scholar
  26. Sornmani S, Okanurak K. (1995). Social and economic impact of dengue haemorrhagic fever in Thailand. Social and Economic Units, Faculty of Tropical Medicine Mahidol University.Google Scholar
  27. Stratton K, Durch JS, Lawrence RS (ed.). (2001). Vaccines for the 21st Century: A tool for Decision Making. National Academy Press, Washington DC.Google Scholar
  28. Strobel M, Lamaury I. (2001). Rev Med Interne. 22: 638–647.PubMedCrossRefGoogle Scholar
  29. Suaya JA, Shepard DS, Beatty ME. (2007). Dengue: burden of disease and costs of illness. Working paper 3.2. In: Report of the Scientific Working Group meeting on Dengue, Geneva, 1–5 October 2006 (TDR/SWG/07). Special Programme for Research and Training in Tropical Diseases (TDR), WHO,, Geneva, Switzerland, pp 35–49.
  30. UNICEF. (1998). The state of the world's children. Accessed 29 January 2002.
  31. United Nations. (2000). Expected births for 2001. In. Statistics Division. Accessed 29 January 2002.
  32. United Nations. (2001). Social indicators. Statistics Division. Accessed 29 January 2002.
  33. United Nations. (2005). World Population Prospects. The 2004 Revision (ESA/P/WP.193). United Nations, New York.
  34. World Bank. (1993). World Development Report: Investing in Health. World Bank, Washington, DC.Google Scholar
  35. World Bank. (2008). World development indicators. Accessed 1 June 2008.
  36. World Health Organization (WHO). (1997). Dengue Hemorrhagic Fever. Diagnosis, Treatment, Prevention and Control. World Health Organization, Geneva.Google Scholar
  37. World Health Organization. (2008). Cost-Effectiveness Thresholds. Choosing Interventions that are Cost Effective (WHO-CHOICE). In World Health Organization, Geneva. Accessed 29 June 2008.

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • D. S. Shepard
    • 1
  • J. A. Suaya
    • 1
  1. 1.Schneider Institutes for Health Policy, Heller SchoolBrandeis UniversityWalthamMA

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