Cost-effectiveness Analysis of Japanese Encephalitis Vaccination for Children <15 Years of Age, Bangladesh

Japanese encephalitis (JE) is preventable using the affordable, effective, and safe live attenuated SA 14-14-2 JE vaccine (CD-JEV). We used a Markov model to evaluate the cost-effectiveness of 1 dose of CD-JEV compared with no vaccination in 3 vaccination strategies in Bangladesh: subnational campaign and routine immunization, subnational campaign and national routine immunization, and national routine immunization alone. For input parameters, we gathered information from a cost-of-illness study, medical literature, government documents, and expert opinions. The base-case analysis estimated that a subnational campaign for children <15 years of age and routine immunization over 20 birth cohorts in Rajshahi, Rangpur, and Chattogram yielded (in 2021 US dollars) a cost of $82.2 million, $981/disability-adjusted life years averted, $9,964/case averted, and $49,819/death averted (societal perspective). We projected CD-JEV vaccination would be cost-effective across cost perspectives and vaccination strategies in Bangladesh, yielding an incremental cost-effectiveness ratio of approximately one third of per capita national gross domestic product.