TY - JOUR
T1 - Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique
T2 - A Modelling Study
AU - Guimarães, Esperança Lourenço
AU - Chissaque, Assucênio
AU - Pecenka, Clint
AU - Debellut, Frédéric
AU - Schuind, Anne
AU - Vaz, Basília
AU - Banze, Arlindo
AU - Rangeiro, Ricardina
AU - Mariano, Arlete
AU - Lorenzoni, Cesaltina
AU - Carrilho, Carla
AU - Martins, Maria do Rosário Oliveira
AU - de Deus, Nilsa
AU - Clark, Andrew
N1 - Funding Information:
This work was supported, in part, by the Bill and Melinda Gates Foundation, through PATH subaward number: GAT.2111-01707508-SUB. Under the grant conditions of the foundation, a Creative Commons Attribution 4.0 generic license has already been assigned to the author accepted manuscript version that might arise from this submission. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill and Melinda Gates Foundation.
Publisher Copyright:
© 2023 by the authors.
PY - 2023/6
Y1 - 2023/6
N2 - Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN® and CERVARIX®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022–2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.
AB - Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN® and CERVARIX®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022–2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.
KW - cervical cancer
KW - cost-effectiveness
KW - modelling
KW - Mozambique
KW - papillomavirus
KW - UNIVAC
KW - vaccination
UR - http://www.scopus.com/inward/record.url?scp=85163754394&partnerID=8YFLogxK
U2 - 10.3390/vaccines11061058
DO - 10.3390/vaccines11061058
M3 - Article
C2 - 37376447
AN - SCOPUS:85163754394
SN - 2076-393X
VL - 11
JO - Vaccines
JF - Vaccines
IS - 6
M1 - 1058
ER -
