Economic evaluation of Wolbachia programmes for dengue control: a systematic review

Background Dengue imposes a substantial and growing global health and economic burden, particularly in tropical and subtropical regions. Wolbachia -based mosquito biocontrol has emerged as a promising strategy to reduce dengue transmission, with substantial evidence demonstrating its epidemiological effectiveness. However, economic evaluations have adopted diverse modelling approaches, analytical perspectives, and assumptions, making comparisons across studies challenging. This study systematically reviews and critically appraises economic evaluations of Wolbachia -based interventions to characterise methodological approaches and assess their influence on estimates of economic value. Methods A systematic review was conducted following PRISMA 2020 guidelines. MEDLINE (Ovid), EMBASE (Ovid), PubMed, and CINAHL were searched to 31 January 2026. Methodological and reporting quality were assessed by independent reviewers using the CHEQUE framework. Results Ten studies met the inclusion criteria, covering settings in Asia and Latin America and predominantly using model-based economic evaluations. Wolbachia interventions were consistently reported as cost-effective and, in several cases cost-saving. Quality appraisal showed that reporting attributes were consistently well-addressed, whereas methodological attributes were more variable. Limitations were most evident in validation practices, handling of uncertainty, and the absence of distributional considerations. Overall quality scores ranged from 59% to 85%, indicating moderate to high quality. Conclusion Wolbachia -based interventions show strong potential as a cost-effective strategy for dengue control. However, current evidence frequently relies on several model-based assumptions and does not fully capture implementation complexity. Strengthening methodological rigour and incorporating implementation considerations will be essential to support policy-relevant decision-making and its sustainable expansion at scale.