The potential cost-effectiveness of controlling dengue in Indonesia using wMel Wolbachia released at scale: a modelling study

Abstract

Background Release of virus-blocking Wolbachia infected mosquitoes is an emerging disease control strategy that aims to control dengue and other arboviral infections. Early entomological data and modelling analyses have suggested promising outcomes and wMel Wolbachia releases are now ongoing or planned in 12 countries. To help inform potential scale-up beyond single city releases, we assessed this technologys cost-effectiveness under different programmatic options. Methods Using costing data from existing Wolbachia releases, previous estimates of Wolbachia effectiveness, and a spatially-explicit model of release and surveillance requirements, we predicted the costs and effectiveness of the on-going programme in Yogyakarta City and three new hypothetical programmes in Yogyakarta Special Autonomous Region, Jakarta and Bali. Results We predicted Wolbachia to be a highly cost-effective intervention when deployed in high density urban areas with gross cost-effectiveness ratios below $1,500 per DALY averted. When offsets from the health system and societal perspective were included, such programmes even became cost saving over 10-year time horizons with favourable benefit-cost ratios of 1.35 to 3.40. Sequencing Wolbachia releases over ten years could reduce programme costs by approximately 38% compared to simultaneous releases everywhere, but also delays the benefits. Even if unexpected challenges occured during deployment, such as emergence of resistance in the medium-term or low effective coverage, Wolbachia would remain a cost saving intervention. Conclusions Wolbachia releases in high density urban areas is expected to be highly cost-effective and could potentially be the first cost saving intervention for dengue. Sites with strong public health infrastructure, fiscal capacity, and community support should be prioritized.

Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education

“…Comparing all scenarios, the result confirmed that combining vaccination with a Wolbachia program within an integrated approach was considered to be the most cost-effective intervention. A previous study investigated the potential cost-effectiveness of a Wolbachia program in Indonesia, which confirmed that Wolbachia released in high density urban areas is expected to be highly cost-effective and could potentially be a cost-saving intervention to prevent dengue infections [47]. In particular, regions with a strong public health infrastructure, fiscal capacity, and community support should be prioritized.…”

“…The results of sensitivity analysis in our study shows that dengue infection rates, underreporting factors for hospitalization, cost of the Wolbachia program, vaccine price, vaccine efficacy, and case fatality rates were considered to be the most influential parameters affecting the cost-effectiveness of integrated dengue vaccination programs. Previous model analyses found the same parameters being most influential in sensitivity analyses [8,30,[47][48][49][50].…”

“…In particular, regions with a strong public health infrastructure, fiscal capacity, and community support should be prioritized. Given that a Wolbachia program is also not predicted to fully eliminate dengue virus transmission in highly endemic settings, there is a need to understand how Wolbachia program interact with other interventions of dengue prevention and how the optimal package of interventions may change in different environments [14,47].…”