Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique: A Modelling Study

Guimarães, Esperança Lourenço; Chissaque, Assucênio; Pecenka, Clint; Debellut, Frédéric; Schuind, Anne; Vaz, Basília; Banze, Arlindo; Rangeiro, Ricardina; Mariano, Arlete; Lorenzoni, Cesaltina; Carrilho, Carla; Martins, Maria do Rosário Oliveira; Deus, Nilsa de; Clark, Andrew

doi:10.3390/vaccines11061058

Cited by 3 publications

(1 citation statement)

References 38 publications

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“…We compared the results of both perspectives to determine whether the CEA identified a common optimal strategy. Using a country-specific willingness-to-pay threshold of 0.3 × gross domestic product per capita (GDPpc) for each DALY averted [ 44 – 46 ], we determined the cost-effective treatments from the patient and health sector perspectives. If the two perspectives identified the same treatment approach as optimal, we confirmed whether the annual cost of the approach exceeded the study’s affordability threshold.…”

Section: Methodsmentioning

confidence: 99%

Framework for determining the optimal course of action when efficiency and affordability measures differ by perspective in cost-effectiveness analysis—with an illustrative case of HIV treatment in Mozambique

Corlis,

Zhu,

Macul

et al. 2023

Cost Eff Resour Alloc

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Background Cost-effectiveness analysis (CEA) is a standard tool for evaluating health programs and informing decisions about resource allocation and prioritization. Most CEAs evaluating health interventions in low- and middle-income countries adopt a health sector perspective, accounting for resources funded by international donors and country governments, while often excluding out-of-pocket expenditures and time costs borne by program beneficiaries. Even when patients’ costs are included, a companion analysis focused on the patient perspective is rarely performed. We view this as a missed opportunity. Methods We developed methods for assessing intervention affordability and evaluating whether optimal interventions from the health sector perspective also represent efficient and affordable options for patients. We mapped the five different patterns that a comparison of the perspective results can yield into a practical framework, and we provided guidance for researchers and decision-makers on how to use results from multiple perspectives. To illustrate the methodology, we conducted a CEA of six HIV treatment delivery models in Mozambique. We conducted a Monte Carlo microsimulation with probabilistic sensitivity analysis from both patient and health sector perspectives, generating incremental cost-effectiveness ratios for the treatment approaches. We also calculated annualized patient costs for the treatment approaches, comparing the costs with an affordability threshold. We then compared the cost-effectiveness and affordability results from the two perspectives using the framework we developed. Results In this case, the two perspectives did not produce a shared optimal approach for HIV treatment at the willingness-to-pay threshold of 0.3 × Mozambique’s annual GDP per capita per DALY averted. However, the clinical 6-month antiretroviral drug distribution strategy, which is optimal from the health sector perspective, is efficient and affordable from the patient perspective. All treatment approaches, except clinical 1-month distributions of antiretroviral drugs which were standard before Covid-19, had an annual cost to patients less than the country’s annual average for out-of-pocket health expenditures. Conclusion Including a patient perspective in CEAs and explicitly considering affordability offers decision-makers additional insights either by confirming that the optimal strategy from the health sector perspective is also efficient and affordable from the patient perspective or by identifying incongruencies in value or affordability that could affect patient participation.

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Section: Methodsmentioning

confidence: 99%

Framework for determining the optimal course of action when efficiency and affordability measures differ by perspective in cost-effectiveness analysis—with an illustrative case of HIV treatment in Mozambique

Corlis,

Zhu,

Macul

et al. 2023

Cost Eff Resour Alloc

View full text Add to dashboard Cite

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Human papillomavirus vaccination at the national level in Tunisia: a cost-effectiveness analysis using a comparative modeling study

Laraj,

Benzina,

Gzara

et al. 2024

Preprint

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Cervical cancer is one of the most prevalent cancer diseases in women caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. Vaccination can significantly reduce the prevalence of this burden in low-middle income countries. However, HPV vaccination is not included in the Tunisian immunization program. Since the economic evaluation of HPV vaccines is crucial to inform public-health decisions, the World Health Organization (WHO) recommends that a cost-effectiveness analysis of HPV vaccination is conducted before nationwide introduction. This study aimed to conduct a cost-effectiveness analysis of incorporating different HPV vaccines into the national immunisation schedule in Tunisia. The potential health and economic impacts of human papillomavirus (HPV) vaccination were evaluated through comparative modelling analysis using two published static models (UNIVAC and Papillomavirus Rapid Interface for Modelling and Economics (PRIME)). Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, vaccine delivery costs and other model parameters. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted and reported as primary outcomes. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET) defined by the World Health Organisation (WHO). All HPV vaccines were very cost effective (with every disability-adjusted life-year averted costing less than the cost-effectiveness threshold). The analyses were done from a health system and societal perspective. Despite model differences, the PRIME and UNIVAC models yielded similar vaccine-impact estimates.

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Accelerating HPV vaccination in Africa for health equity

Asempah,

Ikpebe

2024

glob health res policy

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Cervical cancer is a preventable disease that continues to burden socioeconomically underserved regions, especially in Africa. Vaccination of adolescents who have never had sex with prophylactic human papillomavirus (HPV) vaccines proves effective in preventing the disease. However, vaccine accessibility and availability are two persistent challenges in low-resource settings. For this commentary, a trend analysis is conducted for national HPV vaccination and coverage rates in Africa, a region with high burden of the disease. This is in consideration of the World Health Organization (WHO) strategy to vaccinate 90% of adolescent girls by the age of 15, as part of strategy to eliminate cervical cancer by 2030. The analysis estimated that the rate of incorporating HPV vaccination in national immunization programs in Africa occurs slowly, at a mean wait time of 12 years with estimated coverage rate of 52%. A policy change that harnesses strategic approaches, such as a regionalized vaccination program, is recommended to hasten HPV vaccination for the rest of African countries without a national program.

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Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique: A Modelling Study

Cited by 3 publications

References 38 publications

Framework for determining the optimal course of action when efficiency and affordability measures differ by perspective in cost-effectiveness analysis—with an illustrative case of HIV treatment in Mozambique

Framework for determining the optimal course of action when efficiency and affordability measures differ by perspective in cost-effectiveness analysis—with an illustrative case of HIV treatment in Mozambique

Human papillomavirus vaccination at the national level in Tunisia: a cost-effectiveness analysis using a comparative modeling study

Accelerating HPV vaccination in Africa for health equity

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