Consumer Willingness to Pay for Dengue Vaccine (CYD-TDV, Dengvaxia®) in Brazil; Implications for Future Pricing Considerations

Abstract

Introduction and Objective: Dengue virus is a serious global health problem with an estimated 3.97 billion people at risk for infection worldwide. In December 2015, the first vaccine (CYD-TDV) for dengue prevention was approved in Brazil, developed by Sanofi Pasteur. However, given that the vaccine will potentially be paid via the public health system, information is need regarding consumers’ willingness to pay for the dengue vaccine in the country as well as discussions related to the possible inclusion of this vaccine into the public health system. This was the objective of this research.Methods: We conducted a cross-sectional study with residents of Greater Belo Horizonte, Minas Gerais, about their willingness to pay for the CYD-TDV vaccine.Results: 507 individuals were interviewed. These were mostly female (62.4%) had completed high school (62.17%), were working (74.4%), had private health insurance (64.5%) and did not have dengue (67.4%). The maximum median value of consumers’ willingness to pay for CYD-TDV vaccine is US$33.61 (120.00BRL) for the complete schedule and US$11.20 (40.00BRL) per dose. At the price determined by the Brazil’s regulatory chamber of pharmaceutical products market for the commercialization of Dengvaxia® for three doses, only 17% of the population expressed willingness to pay for this vaccine.Conclusion: Brazil is currently one of the largest markets for dengue vaccine and the price established is a key issue. We believe the manufacturer should asses the possibility of lower prices to reach a larger audience among the Brazilian population.

Cost-effectiveness thresholds: methods for setting and examples from around the world

“…In this method, the threshold is estimated through preference data collected directly from the population with contingent valuation surveys, or indirectly, from the behavior of the individual in the market, WTP for a reduction of mortality or willingness-to-accept (WTA) for a risk [18,41]. These methods are intended to elicit the maximum value that an individual would be willing to disburse to obtain a determined amount of health improvement, usually a small difference in utility aggregated to generate the value for a quality-adjusted life year (QALY) [41,42]. Initially, the utility difference between two health states is estimated, commonly through time trade-off or standard gamble; and then the WTP is elicited for that difference [41,43].…”

“…The contingent valuation method consists on the application of a structured questionnaire with all relevant information about the technologies and comparators, health conditions and context to inform respondents prior to the decision [42,44,45]. The WTP value can be elicited through a direct openended question; a bidding game, with a direct question followed by increases and decreases of value, until a point estimate is reached; payment cards, with values for the respondent to choose; and a discrete choice, where respondents answer a single "yes" or "no" question followed by statistical assessment of the data [42,44]. The questionnaire should, preferably, be applied on face-to-face interviews and respondents must be reminded of the opportunity costs and therapeutic alternatives [45,46].…”

“…The questionnaire should, preferably, be applied on face-to-face interviews and respondents must be reminded of the opportunity costs and therapeutic alternatives [45,46]. Bidding game and discrete choice are more common and reliable methods to assess the WTP [42,44,46,47]. It is worth noting that WTP and WTA values, contrary to initial theoretical predictions, are substantially different from each other.…”

Plant‐expressed Fc‐fusion protein tetravalent dengue vaccine with inherent adjuvant properties

“…However, the Sanofi Pasteur produced Dengvaxia (as it is commercially known) is only partially effective against serotype 2 and most importantly contraindicated in children under the age of nine (Hadinegoro et al, 2015), due to suboptimal responses in this age population and risk of antibodydependent enhancement of infection (ADE). Also, while the vaccine has been cautiously endorsed by the WHO (Wilder-Smith et al, 2016), there remain a number of other issues with this vaccine, including its stability, cost-effectiveness and affordability (Deen et al, 2016;Godoi et al, 2017;Harapan et al, 2017;Shafie et al, 2017).…”

Consumer willingness to pay for a hypothetical Zika vaccine in Brazil and the implications

“…This is likely to the case with any new zika vaccine approved in Brazil. Such WTP studies can also help in decision-making regarding incorporating any new technology into the Brazilian public health system (SUS) [22]. We are aware that there are a number of publications discussing WTP for infectious diseases [22 -34].…”