Title |
Cost-effectiveness analysis of human papillomavirus vaccination in South Africa accounting for human immunodeficiency virus prevalence
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Published in |
BMC Infectious Diseases, December 2015
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DOI | 10.1186/s12879-015-1295-z |
Pubmed ID | |
Authors |
Xiao Li, Martinus P. Stander, Georges Van Kriekinge, Nadia Demarteau |
Abstract |
This study aims at evaluating the cost-effectiveness of a 2-dose schedule human papillomavirus (HPV) vaccination programme of HPV and human immunodeficiency virus (HIV) naïve 12-year-old girls, in addition to cervical cancer (CC) screening alone, in South Africa. The study aims to account for both the impact of the vaccine among girls who are HIV-positive (HIV+) as well as HIV-negative (HIV-) population. A previously published Markov cohort model was adapted to assess the impact and cost-effectiveness of a HPV vaccination programme in girls aged 12 years (N = 527 900) using the AS04-adjuvanted HPV-16/18 vaccine from a public payer perspective. Two subpopulations were considered: HIV- and HIV+ women. Each population followed the HPV natural history with different transition probabilities. Model input data were obtained from the literature, local databases and Delphi panel. Costs and outcomes were discounted at 5 %. Extensive sensitivity analyses were conducted to assess the robustness of the evaluation. Implementation of the AS04-adjuvanted HPV-16/18 vaccine in combination with current cytological screening in South African girls could prevent up to 8 869 CC cases and 5 436 CC deaths over the lifetime of a single cohort. Without discounting, this HPV vaccine is dominant over screening alone; with discounting, the incremental cost-effectiveness ratio is ZAR 81 978 (South African Rand) per quality-adjusted life years (QALY) gained. HPV vaccination can be considered cost-effective based on World Health Organization (WHO) recommended threshold (3 x gross domestic product/capita = ZAR 200 293). In a scenario with a hypothetical targeted vaccination in a HIV+ subpopulation alone, the modelled outcomes suggest that HPV vaccination is still cost-effective, although the incremental cost-effectiveness ratio increases to ZAR 102 479. Results were sensitive to discount rate, vaccine efficacy, HIV incidence and mortality rates, and HPV-related disease transition probabilities. The AS04-adjuvanted HPV-16/18 vaccine can be considered cost-effective in a South African context although the cost-effectiveness is expected to be lower in the HIV+ subpopulation than in the overall female population. With improved access to HIV treatment, the HIV mortality and incidence rates are likely to be reduced, which could improve cost-effectiveness of the vaccination programme in South Africa. |
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Geographical breakdown
Country | Count | As % |
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United Kingdom | 1 | <1% |
Netherlands | 1 | <1% |
Brazil | 1 | <1% |
Unknown | 187 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 34 | 18% |
Unspecified | 31 | 16% |
Researcher | 17 | 9% |
Student > Ph. D. Student | 14 | 7% |
Student > Postgraduate | 11 | 6% |
Other | 32 | 17% |
Unknown | 51 | 27% |
Readers by discipline | Count | As % |
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Unspecified | 31 | 16% |
Nursing and Health Professions | 17 | 9% |
Social Sciences | 14 | 7% |
Economics, Econometrics and Finance | 6 | 3% |
Other | 28 | 15% |
Unknown | 57 | 30% |