Incorporation of the Tetravalent Dengue Vaccine in the at-Risk Population by the Unified Health System in Brazil: A Cost-Benefit Analysis

OBJECTIVES: To analyze the cost-benefit ratio of implementing the tetravalent dengue vaccine within the public healthcare system for the prioritized group of 3.1 million individuals identified by the Ministry of Health in Brazil.

METHODS: The calculation of the number of doses to be procured by the government was predicated upon the target number of individuals slated for immunization and the associated cost for such acquisition. Subsequently, an analysis of both direct and indirect costs was conducted, comparing scenarios with and without vaccine implementation. Direct costs took into account mild, moderate, and severe dengue cases in Brazil, based on the vaccine's efficacy as per the manufacturer's specifications. Indirect costs assessed lost workdays and mortality. The investment amount was derived from data provided by the Ministry of Health before, during, and after negotiations with the company.

RESULTS: The cost for acquiring the 6.2 million doses of the vaccine is approximately 589 million Brazilian Reais (approximately 120.4 million US dollars), while the savings amount to approximately 12 million Brazilian Reais (less than 2.5 million US dollars). Among the calculated costs, the indirect cost per dengue-related death was the most significant factor in the calculation, with potential savings of just over 6 million Brazilian Reais (approximately 1.2 million US dollars). The cost-benefit ratio revealed that for every 1 BRL (4.89 USD) invested, there would be a savings of only 2 cents (0.0041 USD).

CONCLUSIONS: Despite Brazil being one of the countries with the highest prevalence of dengue in Latin America, the acquisition of the tetravalent dengue vaccine does not appear to be a favorable option, given that the costs are considerably high when compared to the returns. Negotiating for the purchase of vaccine technology and subsequent in-country production may be more economically advantageous; therefore, it is imperative that further studies be conducted to analyze this scenario.