Journal
VACCINE
Volume 34, Issue 19, Pages 2197-2206Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.vaccine.2016.03.018
Keywords
Hookworm; Transmission; Vaccine; Drug treatment; Economics; Cost
Categories
Funding
- Agency for Healthcare Research and Quality (AHRQ) [R01HS023317]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Institute for General Medical Science (NIGMS) via MIDAS [5U24GM110707]
- Office of Behavioral and Social Sciences Research (OBSSR)
- Global Obesity Prevention Center (GOPC) [U54HD070725]
- NICHD [U01 HD086861]
- Bill and Melinda Gates Foundation
- USAID [AID-OAA-A-15-00064]
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Background: 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 <= 8444/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. (C) 2016 Elsevier Ltd. All rights reserved.
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