• Sarah M Bartsch, Lindsey Asti, Owen J Stokes-Cawley, So Yoon Sim, Maria Elena Bottazzi, Peter J Hotez, and Bruce Y Lee.
• Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York, New York City, New York.
• Am J Prev Med. 2020 Mar 1; 58 (3): 370-377.

IntroductionWith Zika vaccine candidates under development and women of childbearing age being the primary target population, now is the time to map the vaccine (e.g., efficacy and duration of protection) and vaccination (e.g., cost) characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving.MethodsA Markov model was developed (to represent 2019 circumstances, US$ and INT$, Region of the Americas) to simulate a woman of childbearing age and the potential risk and clinical course of a Zika infection.ResultsCompared with no vaccination, vaccination was cost effective (incremental cost-effectiveness ratio: US$1,254-$82,900/disability-adjusted life years averted) when the risk of infection was ≥0.05%-0.08% (varying with country income), vaccine efficacy was ≥25%, and vaccination cost was US$1-$7,500 (INT$5-$10,000 depending on country income level). Vaccination was dominant (i.e., saved costs and provided beneficial health effects) when the infection risk was ≥0.1% for a vaccine efficacy ≥75% and when the infection risk was ≥0.5% for a vaccine efficacy ≥25%, for scenarios where vaccination conferred a 1-year duration of protection and cost ≤$200. In some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500 (INT$10,000), the efficacy was as low as 25%, and the duration of protection was 1 year.ConclusionsThe thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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