Economic value of pre-travel health interventions for communicable diseases in international travellers.

Abstract

Background: Pre-travel health interventions can reduce the acquisition of communicable diseases and decrease the risk of transmission during or after international travel. We sought to inform policy and research priorities with a scoping literature review of studies that assess the cost-effectiveness of pre-travel interventions.

Methods: We assessed 44 economic evaluation studies published from 1946-2023, regarding pre-travel prevention of hepatitis A, hepatitis B, influenza, malaria, rabies, travellers' diarrhoea, cholera, polio, typhoid fever, measles, and Japanese encephalitis.

Results: Published studies demonstrate that hepatitis A vaccination, malaria chemoprophylaxis and typhoid vaccination for people travelling to highly endemic settings are likely to be cost-effective, as is measles-mumps-rubella vaccination. The cost-effectiveness of other pre-travel interventions is more sensitive to travel frequency and duration, endemicity at the travel destination, travel purpose (e.g. business, leisure, visiting friends and relatives), risk perceptions (e.g. adherence to care plan, choosing to vaccinate), and costs.

Conclusions: Cost-effectiveness analyses of pre-travel interventions can inform the value of such interventions, but such analyses depend on the availability of high-quality data regarding clinical outcomes and costs. We propose that international, collaborative networks should collect data and leverage novel technologies to expand the evidence base regarding the risks of exposure, clinical outcomes, risk perception, and costs associated with pre-travel interventions. This evidence base can inform recommendations for specific groups of travellers and the formulation of population-specific health policies.