The cost-effectiveness of controlling dengue in Indonesia usingwMel Wolbachiareleased at scale: a modelling study

Background: Release of virus-blocking Wolbachia-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 wMel Wolbachia releases are now ongoing or planned in 12 countries. To help
inform government, donor, or philanthropist decisions on scale-up beyond single city releases, we assessed this
technology’s cost-effectiveness under alternative programmatic options.
Methods: Using costing data from existing Wolbachia releases, previous dynamic model-based estimates of
Wolbachia effectiveness, and a spatially explicit model of release and surveillance requirements, we predicted the
costs and effectiveness of the ongoing programme in Yogyakarta City and three new hypothetical programmes in
Yogyakarta Special Autonomous Region, Jakarta, and Bali.
Results: We predicted Wolbachia to be a highly cost-effective intervention when deployed in high-density urban
areas with gross cost-effectiveness below $1500 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 Wolbachia releases over 10 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, Wolbachia would remain a cost-saving intervention.
Conclusions: Wolbachia releases in high-density urban areas are 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 prioritised.