Dataset Information

Reducing dengue fever cases at the lowest budget: a constrained optimization approach applied to Thailand.

ABSTRACT:

Background

With the challenges that dengue fever (DF) presents to healthcare systems and societies, public health officials must determine where best to allocate scarce resources and restricted budgets. Constrained optimization (CO) helps to address some of the acknowledged limitations of conventional health economic analyses and has typically been used to identify the optimal allocation of resources across interventions subject to a variety of constraints.

Methods

A dynamic transmission model was developed to predict the number of dengue cases in Thailand at steady state. A CO was then applied to identify the optimal combination of interventions (release of Wolbachia-infected mosquitoes and paediatric vaccination) within the constraints of a fixed budget, set no higher than cost estimates of the current vector control programme, to minimize the number of dengue cases and disability-adjusted life years (DALYs) lost. Epidemiological, cost, and effectiveness data were informed by national data and the research literature. The time horizon was 10 years. Scenario analyses examined different disease management and intervention costs, budget constraints, vaccine efficacy, and optimization time horizon.

Results

Under base-case budget constraints, the optimal coverage of the two interventions to minimize dengue incidence was predicted to be nearly equal (Wolbachia 50%; paediatric vaccination 49%) with corresponding coverages under lower bound (Wolbachia 54%; paediatric vaccination 10%) and upper bound (Wolbachia 67%; paediatric vaccination 100%) budget ceilings. Scenario analyses indicated that the most impactful situations related to the costs of Wolbachia and paediatric vaccination with decreases/ increases in costs of interventions demonstrating a direct correlation with coverage (increases/ decreases) of the respective control strategies under examination.

Conclusions

Determining the best investment strategy for dengue control requires the identification of the optimal mix of interventions to implement in order to maximize public health outcomes, often under fixed budget constraints. A CO model was developed with the objective of minimizing dengue cases (and DALYs lost) over a 10-year time horizon, within the constraints of the estimated budgets for vector control in the absence of vaccination and Wolbachia. The model provides a tool for developing estimates of optimal coverage of combined dengue control strategies that minimize dengue burden at the lowest budget.

SUBMITTER: Knerer G

PROVIDER: S-EPMC8080389 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The 3-5year epidemic cycle of dengue fever in Thailand makes it a major re-emerging public health problem resulting in being a burden in endemic areas. Although the Thai Ministry of Public Health adopted the WHO dengue control strategy, all dengue virus serotypes continue to circulate. Health officers and village health volunteers implement some intervention options but there is a need to ascertain most appropriate (or a combination of) interventions regarding the environment and contextual factors that may undermine the effectiveness of such interventions. This study aims to understand the dengue-climate relationship patterns at the district level in the southern region of Thailand from 2002 to 2018 by examining the statistical association between dengue incidence rate and eight environmental patterns, testing the hypothesis of equal incidence of these. Data on environmental variables and dengue reported cases in Nakhon Si Thammarat province situated in the south of Thailand from 2002 to 2018 were analysed to (1) detect the environmental factors that affect the risk of dengue infectious disease; to (2) determine if disease risk is increasing or decreasing over time; and to (3) identify the high-risk district areas for dengue cases that need to be targeted for interventions. To identify the predictors that have a high and significant impact on reported dengue infection, three steps of analysis were used. First, we used Partial Least Squares (PLS) Regression and Poisson Regression, a variant of the Generalized Linear Model (GLM). Negative co-efficient in correspondence with the PLS components suggests that sea-level pressure, wind speed, and pan evaporation are associated with dengue occurrence rate, while other variables were positively associated. Using the Akaike information criterion in the stepwise GLM, the filtered predictors were temperature, precipitation, cloudiness, and sea level pressure with the standardized coefficients showing that the most influential variable is cloud cover (three times more than temperature and precipitation). Also, dengue occurrence showed a constant negative response to the average increase in sea-level pressure values. In southern Thailand, the predictors that have been locally determined to drive dengue occurrence are temperature, rainfall, cloud cover, and sea-level pressure. These explanatory variables should have important future implications for epidemiological studies of mosquito-borne diseases, particularly at the district level. Predictive indicators guide effective and dynamic risk assessments, targeting pre-emptive interventions.