Economic evaluation of interventions for dengue fever and dengue haemorrhagic fever in resource-poor settings, using the example of Thailand

Abstract

Dengue fever has become a major public health problem. It is considered one of the most important mosquito-borne viral diseases and occurs in >100 countries in tropical and subtropical regions of Asia-Pacific, the Americas, the Middle East, and Africa with >3 billion people at risk. Despite current control interventions against dengue fever in endemic countries, the disease is associated with considerable healthcare utilisation, personal costs to patients and caregivers, productivity loss, and human suffering. Whilst the illness is well understood, there is also recognition that current control efforts focussing predominantly on Aedes aegypti control and elimination are less than optimal, although they may still have an important role to play in the short to medium term. In this thesis, the epidemiological and economic impacts of dengue control interventions in Thailand, a geographical setting with a persistent, high level of dengue transmission areinvestigated, embracing chemical interventions (adulticide and larvicide), environmental control/ public health education and awareness, paediatric vaccination (using dengue vaccine profile[s] broadly consistent with [dengue] vaccines in late-stage development) and, in anticipation of possible new vector-control technologies, Wolbachia-infected mosquitoes. The premise that is being examined is not the ‘how’ of implementation, rather what the possible population impacts of different interventions are (both individually and in combination). Using three different and complementary analyses (epidemiological impact, i.e. effectiveness, cost-effectiveness analysis, and constrained optimisation), our findings show that the most useful method to reduce dengue burden (in terms of cases, costeffectiveness, and affordability, respectively) would be to combine vaccination with other form(s) of control, e.g. adulticide, environmental control/ public health education and awareness, and Wolbachia.

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Identifiers

ORCID for Sally Brailsford: orcid.org/0000-0002-6665-8230

ORCID for Christine Currie: orcid.org/0000-0002-7016-3652

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