Exploring the cost-effectiveness of HPV vaccination in Vietnam: Insights for evidence-based cervical cancer prevention policy

Department of Health Policy and Management, Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA.
Vaccine (Impact Factor: 3.49). 07/2008; 26(32):4015-24. DOI: 10.1016/j.vaccine.2008.05.038
Source: PubMed

ABSTRACT Using mathematical models of cervical cancer for the northern and southern regions of Vietnam, we assessed the cost-effectiveness of cervical cancer prevention strategies and the tradeoffs between a national and region-based policy in Vietnam. With 70% vaccination and screening coverage, lifetime risk of cancer was reduced by 20.4-76.1% with vaccination of pre-adolescent girls and/or screening of older women. Only when the cost per vaccinated girl was low (i.e., <I$25) was vaccination combined with screening (three times per lifetime or every 5 years) favored in both regions; at high costs per vaccinated girl (i.e., >I$100), screening alone was most cost-effective. When optimal policies differed between regions, implementing a national strategy resulted in health and economic inefficiencies. HPV vaccination appears to be an attractive cervical cancer prevention strategy for Vietnam, provided high coverage can be achieved in young pre-adolescent girls, cost per vaccinated girl is <I$25 (i.e., <$5 per dose), and screening is offered at older ages.

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    • "Health outcomes were reported as a mean and range of results, while incremental cost-effectiveness ratios were reported as the ratio of the difference in mean costs divided by the difference in mean effects across the good-fitting parameter sets for one strategy compared with the next best alternative. The calibration process has been previously described [30] [31] [32] [33] [34] [35] [36] and details of the calibration data, methods, and results for all three countries are provided in the Appendix. Strategies that were evaluated in this analysis include: (1) HPV16/18 vaccination of pre-adolescent girls (by age 12); (2) screening alone; and (3) combined pre-adolescent HPV16/18 vaccination and screening. "
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    ABSTRACT: To date, no studies have evaluated the cost-effectiveness of human papillomavirus (HPV) vaccination in countries in the Extended Middle East and North Africa (EMENA) region. We synthesized population and epidemiologic data for 20 EMENA countries using a model-based approach to estimate averted cervical cancer cases and deaths, disability-adjusted life years (DALYs) and cost-effectiveness ratios (I$ [international dollars] per DALY averted) associated with HPV vaccination of pre-adolescent girls. We utilized additional epidemiologic data from Algeria, Lebanon, and Turkey to evaluate select cervical cancer screening strategies either alone or in combination with vaccination. Results showed that pre-adolescent vaccination of five consecutive birth cohorts at 70% coverage has the potential to prevent over 180,000 cervical cancer cases. Cases averted varied by country, largely due to differences in cancer burden and population size; 69% of cases averted occurred in the three GAVI-eligible countries in EMENA. Despite the low cervical cancer incidence in EMENA, we found that HPV vaccination was cost-effective using a threshold of each country's gross domestic product per capita (a common metric for evaluating cost-effectiveness) in all but five countries at a cost per vaccinated girl of I$25 ($5 per dose). However, cost-effectiveness diminished with increasing vaccine cost; at a cost of I$200 per vaccinated girl, HPV vaccination was cost-effective in only five countries. When the cost per vaccinated girl exceeded I$50 in Lebanon and Turkey and I$150 in Algeria, screening alone was most attractive. We identified opportunities to improve upon current national screening guidelines, involving less frequent screening every 3-5 years. While pre-adolescent HPV vaccination promises to be a cost-effective strategy in most EMENA countries at low costs, decision makers will need to consider many other factors, such as affordability, acceptability, feasibility, and competing health priorities, when making decisions about cervical cancer prevention. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region" Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
    Vaccine 12/2013; 31S6:G65-G77. DOI:10.1016/j.vaccine.2012.06.096 · 3.49 Impact Factor
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    • "found that vaccination combined with regular 5-yearly screening was not cost-effective even at low CVGs because the incremental costs were too expensive compared to vaccination combined with twice-lifetime screening. For HBV vaccination in China, the proportion of total vaccination costs related to direct vaccine costs for 3 doses has been reported as 56–75% [30] [31] [32]; this range is consistent with prior HPV vaccination evaluations in developing countries [14] [33] [34]. Thus, the maximum vaccine unit cost per dose in order for strategies involving vaccination to be cost-effective, implied by our maximum CVG of $50–54, is $9–14 (Table 2). "
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    ABSTRACT: Comprehensive evaluation of the cost-effectiveness of HPV vaccination in China has not previously been performed. The objective of this study was to evaluate vaccination as an alternative or addition to primary HPV screening with careHPV (Qiagen, Gaithersburg, USA), and to assess the threshold total cost per vaccinated girl (CVG) at which strategies involving vaccination would become viable compared to screening-only strategies in rural China. We used data from field studies in Shanxi Province to support modelling of HPV vaccination and screening, including local information on sexual behaviour, HPV prevalence, test accuracy, treatment protocols and costs. We evaluated several strategies involving screening once or twice per lifetime or at regular 5-yearly intervals, with or without vaccination of young females at age 15 years, assuming 70% coverage for both screening and vaccination. We also predicted cross-sectional cancer incidence each year to the year 2050 for a range of strategies. We found that strategies involving vaccination would be cost-effective at CVGs of US$50-54 or less, but at CVGs >$54, screening-only strategies would be more cost-effective. If vaccination of young cohorts is combined with two rounds of careHPV screening for women aged 30-59 years in 2012 and 2027, a predicted indicative 33% reduction in cervical cancer incidence by 2030 would be sustained until 2050, with incidence rates decreasing thereafter. In conclusion, taking into account estimated vaccine delivery costs (for 3 doses), a per-dose HPV vaccine cost of approximately <$9-14 would be required for strategies involving vaccination to be cost-effective. Overall, combined screening and vaccination approaches are required to maximise outcomes in rural China.
    Vaccine 03/2011; 29(13):2487-94. DOI:10.1016/j.vaccine.2010.12.085 · 3.49 Impact Factor
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    ABSTRACT: Using population-based and epidemiologic data for 25 countries in Asia (22 GAVI-Alliance eligible countries, Thailand, China and Japan), a model-based approach was used to estimate averted cervical cancer cases and deaths, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (I$/DALY averted) for vaccination of young adolescent girls against human papillomavirus (HPV) types 16 and 18. Absolute reduction in lifetime cancer risk varied between countries, depending on incidence, proportion attributable to HPV-16 and -18, and population age-structure; for example, with 70% coverage, cancer reduction was 57% in Indonesia, whereas in Cambodia, it was 49%. Screening of women over age 30 three times per lifetime, after vaccinating them as pre-adolescents, is expected to provide an additional 20% to 30% mortality reduction. Of the 22 GAVI-Alliance eligible countries, India, Bangladesh, Vietnam and Indonesia account for 87% of the total DALYs averted. Assuming a cost per vaccinated girl of I$10 ($2 per dose), the cost per DALY averted is less than I$250 in 18 of 22 countries. Assuming a cost per vaccinated girl of I$25, the cost per DALY averted is I$1,360 in China compared with I$250 in Thailand, reflecting the greater number of girls that need to be vaccinated to prevent a death from cervical cancer in China. Vaccine price has an even greater effect on predicted affordability. For the 22 GAVI Alliance-eligible countries, vaccinating 5 consecutive birth cohorts at 70% coverage would cost over US $500 million versus almost US $1.3 billion at per dose costs of $2 and $5, respectively. Including China and Thailand would add US $251 million to US $1.4 billion at per dose prices of $2 and $12.25, respectively. In the countries we assessed, vaccination of young adolescent girls against HPV-16 and -18 could be very cost-effective if the cost per vaccinated girl is less than I$10-I$25; for it to be affordable, however, even with financing assistance, vaccine prices may need to be even lower.
    Vaccine 08/2008; 26 Suppl 12:M17-29. DOI:10.1016/j.vaccine.2008.06.018 · 3.49 Impact Factor
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