The potential cost-effectiveness of controlling dengue in Indonesia using <i>wMel Wolbachia</i> released at scale: a modelling study

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Release of virus-blocking <jats:italic>Wolbachia</jats:italic> infected mosquitoes is an emerging disease control strategy that aims to control dengue and other arboviral infections. Early entomological data and modelling analyses have suggested promising outcomes and <jats:italic>wMel Wolbachia</jats:italic> releases are now ongoing or planned in 12 countries. To help inform potential scale-up beyond single city releases, we assessed this technology’s cost-effectiveness under different programmatic options.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Using costing data from existing <jats:italic>Wolbachia</jats:italic> releases, previous estimates of <jats:italic>Wolbachia</jats:italic> effectiveness, and a spatially-explicit model of release and surveillance requirements, we predicted the costs and effectiveness of the on-going programme in Yogyakarta City and three new hypothetical programmes in Yogyakarta Special Autonomous Region, Jakarta and Bali.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We predicted <jats:italic>Wolbachia</jats:italic> to be a highly cost-effective intervention when deployed in high density urban areas with gross cost-effectiveness ratios below $1,500 per DALY averted. When offsets from the health system and societal perspective were included, such programmes even became cost saving over 10-year time horizons with favourable benefit-cost ratios of 1.35 to 3.40. Sequencing <jats:italic>Wolbachia</jats:italic> releases over ten years could reduce programme costs by approximately 38% compared to simultaneous releases everywhere, but also delays the benefits. Even if unexpected challenges occurred during deployment, such as emergence of resistance in the medium-term or low effective coverage, <jats:italic>Wolbachia</jats:italic> would remain a cost saving intervention.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:italic>Wolbachia</jats:italic> releases in high density urban areas is expected to be highly cost-effective and could potentially be the first cost saving intervention for dengue. Sites with strong public health infrastructure, fiscal capacity, and community support should be prioritized.</jats:p></jats:sec>