Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico

Kenneth (John) McConnell, Duane J. Gubler

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective. In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. Design and Methods. Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. Results. In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50% and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50% and that costs less than US$ 4.50 per person would be expected to be cost-effective. Conclusions. Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks.

Original languageEnglish (US)
Pages (from-to)9-16
Number of pages8
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Volume14
Issue number1
StatePublished - Jul 1 2003

Fingerprint

Puerto Rico
Dengue
Cost-Benefit Analysis
Guidelines
Costs and Cost Analysis
costs
cost
early warning system
Cost Control
Disease Outbreaks
Emergencies
mosquito
Economics
human being
Mosquito Control
West Indies
programme
Dengue Virus
Aedes
Salaries and Fringe Benefits

Keywords

  • Cost-benefit analysis
  • Dengue
  • Disease outbreaks
  • Epidemiologic measurements
  • Mosquito control

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Geography, Planning and Development

Cite this

@article{2f8f843cf3ef44098c982de49a4090d5,
title = "Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico",
abstract = "Objective. In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. Design and Methods. Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. Results. In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50{\%} and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50{\%} and that costs less than US$ 4.50 per person would be expected to be cost-effective. Conclusions. Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks.",
keywords = "Cost-benefit analysis, Dengue, Disease outbreaks, Epidemiologic measurements, Mosquito control",
author = "McConnell, {Kenneth (John)} and Gubler, {Duane J.}",
year = "2003",
month = "7",
day = "1",
language = "English (US)",
volume = "14",
pages = "9--16",
journal = "Revista Panamericana de Salud Publica/Pan American Journal of Public Health",
issn = "1020-4989",
publisher = "Pan American Health Organization",
number = "1",

}

TY - JOUR

T1 - Guidelines on the cost-effectiveness of larval control programs to reduce dengue transmission in Puerto Rico

AU - McConnell, Kenneth (John)

AU - Gubler, Duane J.

PY - 2003/7/1

Y1 - 2003/7/1

N2 - Objective. In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. Design and Methods. Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. Results. In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50% and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50% and that costs less than US$ 4.50 per person would be expected to be cost-effective. Conclusions. Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks.

AB - Objective. In the past 20 years, the emphasis for avoiding dengue epidemics has focused on larval control of Aedes aegypti, the principal mosquito vector of dengue viruses. A general consensus is that mosquito larval control holds the best promise for reducing dengue epidemics, although its actual effectiveness is still unknown and subject to a great deal of uncertainty. The objective of this research was to assess the cost-effectiveness of emergency larval control programs for reducing dengue transmission in the Caribbean island of Puerto Rico and to develop guidelines to help choose between carrying out a rapid-response, emergency larval control intervention and not conducting such an intervention. Design and Methods. Data on dengue transmission and its likely impacts in Puerto Rico were used as a case study to develop intervention guidelines. A distribution of economic impacts was simulated using available data on disease rates and economic variables, including the costs of treating patients and the opportunity costs represented by lost wages. Successful larval control interventions were assessed by determining two parameters: (1) the costs of an intervention and (2) the expected reduction in the reported case rate of dengue. In addition, we examined how these guidelines would change with an early warning system that provides information on a possible outbreak of dengue. Results. In Puerto Rico, larval control programs that are expected to reduce dengue transmission by 50% and cost less than US$ 2.50 per person will be cost-effective. Programs that cost more per person but that further reduce transmission are still likely to be cost-effective. Having an early warning system, even one that provides a low level of accuracy, can extend the range of larval control programs that are cost-effective. For example, with an early warning system, a larval control program that reduces dengue transmission by 50% and that costs less than US$ 4.50 per person would be expected to be cost-effective. Conclusions. Guidelines such as the ones that we developed for Puerto Rico can be useful to public health authorities in helping to decide whether or not to spend resources for a larval control program to reduce dengue transmission. The range of larval control interventions that are cost-effective can be increased by having an early warning system that provides even a small amount of information regarding possible outbreaks.

KW - Cost-benefit analysis

KW - Dengue

KW - Disease outbreaks

KW - Epidemiologic measurements

KW - Mosquito control

UR - http://www.scopus.com/inward/record.url?scp=0042426017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0042426017&partnerID=8YFLogxK

M3 - Article

VL - 14

SP - 9

EP - 16

JO - Revista Panamericana de Salud Publica/Pan American Journal of Public Health

JF - Revista Panamericana de Salud Publica/Pan American Journal of Public Health

SN - 1020-4989

IS - 1

ER -