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Analysis of the Full Economic Cost for Japanese Encephalitis Under Different Risk Scenarios for Business Travelers to Asia

Rogers, William H., PhD; Bunn, William B. III, MD, JD, MPH; Lerner, Debra, MSc, PhD

Journal of Occupational and Environmental Medicine: January 2019 - Volume 61 - Issue 1 - p 16–20
doi: 10.1097/JOM.0000000000001474

Objective: Methods for assessing the costs and benefits of administering vaccines to international business/occupational travelers, assignees, and expatriates have neglected the impact of health and treatment on work productivity. The research objective is to evaluate the benefit to cost ratio of the Japanese encephalitis (JE) vaccine for international business/occupational travelers to Asia and other endemic areas incorporating a health and productivity approach.

Methods: Costs and benefits were estimated using actuarial methods with data obtained from secondary sources describing prevalence of infection risk and health outcomes, and business traveler demographic and travel characteristics. Results assumed 2018 salaries and prices, with employee time valued according to total compensation.

Results: Risks contracting JE vary widely on the basis of length of trip, season, and destination. The productivity benefits of vaccinating a traveler outweigh the vaccination costs for those staying 30 days or longer in endemic areas during one or more transmission seasons ($2009 vs $750 per traveler), and for business travelers to endemic areas during the transmission season with outdoor activities for the average 2-week/15.4-day international business trip ($502 to $815 vs $500). Vaccination costs outweigh the productivity benefits for short-term travelers who remain in urban areas or travel outside of the transmission season ($10 vs $500).

Conclusion: JE Vaccination for business travelers in the active transmission season has a net benefit under certain conditions that are not commonly considered risky, such as average-length trips to peri-urban areas, in situations where contracting disease would result in significant business disruption, or when multiple trips are anticipated over several years.

Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (Dr Rogers), Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina (Dr Bunn III), and Program on Health, Work and Productivity, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (Dr Lerner).

Address correspondence to: William H. Rogers, PhD, Tufts Medical Center, 800 Washington Street, Box 345, Boston, MA 02111 (

Funding for this paper was provided by the Institute for Health and Productivity Management (IHPM) with financial support from Valneva USA.

Valneva did not have a veto over publication.

Rogers, Bunn, and Lerner have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2019 by the American College of Occupational and Environmental Medicine