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

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

Example structures of dengue models.

<p>The disease state space of five alternative dengue model structures incorporating immune enhancement and short-term cross protection are shown. The disease states are: <i>S</i> susceptible, <i>E</i> exposed but not yet infectious, <i>I</i>_i infectious with serotype <i>i</i>, <i>I</i>_ij infectious with serotype <i>j</i> having had serotype <i>i</i>, <i>R</i>_i recovered from and immune to serotype <i>i</i>, <i>Z</i>_ij recovered from and immune to serotypes <i>i</i> and <i>j</i> and hence immune to all serotypes, <i>C</i> temporarily cross-protected from all serotypes due to recent exposure. Model (<i>a</i>): individuals immune to one serotype are more likely to experience a severe infection (denoted by red box). Model (<i>b</i>): similar to model <i>a</i> with the addition of a pre-infectious exposed class <i>E</i>. Model (<i>c</i>): includes a short-term cross-protection class <i>C</i> in which recently recovered individuals are protected from infection for a certain amount of time. Model (<i>d</i>): model with short-term cross-protection and increased infectiousness of class <i>I</i>_ij indicated by red arrows showing an increase in the rates of acquisition of primary and secondary infection due to this effect. Model (<i>e</i>): increased transmissibility among secondary infections <i>I</i>_ij to a mosquito species. Note that in this formulation, mosquitoes that have obtained infection from a secondary human infection are not more likely to transmit to humans. Subscripts <i>h</i> and <i>m</i> denote human and mosquito, respectively.</p

Prospective Dengue Cohort Studies.

<p>Prospective Dengue Cohort Studies.</p