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Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame

Author

Listed:
  • Kamran Badizadegan

    (Kid Risk, Inc., Orlando, FL, USA)

  • Dominika A. Kalkowska

    (Kid Risk, Inc., Orlando, FL, USA)

  • Kimberly M. Thompson

    (Kid Risk, Inc., Orlando, FL, USA)

Abstract

Background Polio antiviral drugs (PAVDs) may provide a critical tool in the eradication endgame by stopping poliovirus infections in immunodeficient individuals who may not clear the virus without therapeutic intervention. Although prolonged/chronic poliovirus excreters are rare, they represent a source of poliovirus reintroduction into the general population. Prior studies that assumed the successful cessation of all oral poliovirus vaccine (OPV) use estimated the potential upper bound of the incremental net benefits (INBs) of resource investments in research and development of PAVDs. However, delays in polio eradication, OPV cessation, and the development of PAVDs necessitate an updated economic analysis to reevaluate the costs and benefits of further investments in PAVDs. Methods Using a global integrated model of polio transmission, immunity, vaccine dynamics, risks, and economics, we explore the risks of reintroduction of polio transmission due to immunodeficiency-related vaccine-derived poliovirus (iVDPV) excreters and reevaluate the upper bound of the INBs of PAVDs. Results Under the current conditions, for which the use of OPV will likely continue for the foreseeable future, even with successful eradication of type 1 wild poliovirus by the end of 2023 and continued use of Sabin OPV for outbreak response, we estimate an upper bound INB of 60 million US$2019. With >100 million US$2019 already invested in PAVD development and with the introduction of novel OPVs that are less likely to revert to neurovirulence, our analysis suggests the expected INBs of PAVDs would not offset their costs. Conclusions While PAVDs could play an important role in the polio endgame, their expected economic benefits drop with ongoing OPV use and poliovirus transmissions. However, stakeholders may pursue the development of PAVDs as a desired product regardless of their economic benefits. Highlights While polio antiviral drugs could play an important role in the polio endgame, their expected economic benefits continue to drop with delays in polio eradication and the continued use of oral poliovirus vaccines. The incremental net benefits of investments in polio antiviral drug development and screening for immunodeficiency-related circulating polioviruses are small. Limited global resources are better spent on increasing global population immunity to polioviruses to stop and prevent poliovirus transmission.

Suggested Citation

  • Kamran Badizadegan & Dominika A. Kalkowska & Kimberly M. Thompson, 2023. "Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame," Medical Decision Making, , vol. 43(7-8), pages 850-862, October.
    • Handle: RePEc:sae:medema:v:43:y:2023:i:7-8:p:850-862
    DOI: 10.1177/0272989X231191127
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    References listed on IDEAS

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    1. Dominika A. Kalkowska & Mark A. Pallansch & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2021. "Global Transmission of Live Polioviruses: Updated Dynamic Modeling of the Polio Endgame," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 248-265, February.
    2. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Olen M. Kew & Roland W. Sutter & R. Bruce Aylward & Margaret Watkins & Howard Gary & James Alexander & Hamid Jafari & Stephen L. Cochi & Kimberly M. T, 2008. "Uncertainty and Sensitivity Analyses of a Decision Analytic Model for Posteradication Polio Risk Management," Risk Analysis, John Wiley & Sons, vol. 28(4), pages 855-876, August.
    3. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "An Updated Economic Analysis of the Global Polio Eradication Initiative," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 393-406, February.
    4. Dominika A. Kalkowska & Kimberly M. Thompson, 2021. "Health and Economic Outcomes Associated with Polio Vaccine Policy Options: 2019–2029," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 364-375, February.
    5. Dominika A. Kalkowska & Kimberly M. Thompson, 2021. "Expected Implications of Globally Coordinated Cessation of Serotype 3 Oral Poliovirus Vaccine (OPV) Before Serotype 1 OPV," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 312-319, February.
    6. Dominika A. Kalkowska & Mark A. Pallansch & Stephen L. Cochi & Stephanie D. Kovacs & Steven G. F. Wassilak & Kimberly M. Thompson, 2021. "Updated Characterization of Post‐OPV Cessation Risks: Lessons from 2019 Serotype 2 Outbreaks and Implications for the Probability of OPV Restart," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 320-328, February.
    7. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Dominika A. Kalkowska & Steven G. F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Characterizing Poliovirus Transmission and Evolution: Insights from Modeling Experiences with Wild and Vaccine‐Related Polioviruses," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 703-749, April.
    8. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "Potential Future Use, Costs, and Value of Poliovirus Vaccines," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 349-363, February.
    9. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Jong‐Hoon Kim & Cara C. Burns & Olen M. Kew & M. Steven Oberste & Ousmane M. Diop & Steven G.F. Wassilak & Stephen L. Cochi & Kimberly M. Thompson, 2013. "Oral Poliovirus Vaccine Evolution and Insights Relevant to Modeling the Risks of Circulating Vaccine‐Derived Polioviruses (cVDPVs)," Risk Analysis, John Wiley & Sons, vol. 33(4), pages 680-702, April.
    10. Kimberly M. Thompson & Dominika A. Kalkowska, 2021. "Reflections on Modeling Poliovirus Transmission and the Polio Eradication Endgame," Risk Analysis, John Wiley & Sons, vol. 41(2), pages 229-247, February.
    11. Radboud J. Duintjer Tebbens & Mark A. Pallansch & Olen M. Kew & Victor M. Cáceres & Hamid Jafari & Stephen L. Cochi & Roland W. Sutter & R. Bruce Aylward & Kimberly M. Thompson, 2006. "Risks of Paralytic Disease Due to Wild or Vaccine‐Derived Poliovirus After Eradication," Risk Analysis, John Wiley & Sons, vol. 26(6), pages 1471-1505, December.
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