Elsevier

Vaccine

Volume 38, Issue 2, 10 January 2020, Pages 165-172
Vaccine

Cost-effectiveness of the introduction of two-dose bi-valent (Cervarix) and quadrivalent (Gardasil) HPV vaccination for adolescent girls in Bangladesh

https://doi.org/10.1016/j.vaccine.2019.10.037Get rights and content

Highlights

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    These 4vHPV and 2vHPV vaccines evaluation considered health system perspective.

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    The bivalent vaccination was found to be cost-effective at Gavi-negotiated prices in Bangladesh.

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    This vaccine offers substantial future benefits for preadolescents in Bangladesh.

Abstract

Background

Cervical cancer is one of the most prevalent cancers in women caused by the human papillomavirus (HPV) that leads to a substantial disease burden for health systems. Prevention through vaccination can significantly reduce the prevalence of cervical cancer. The objective of this study is to evaluate the potential health and economic impacts of introducing two-dose bivalent (Cervarix) and quadrivalent (Gardasil) HPV vaccines in Bangladesh.

Methods

The study uses the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to assess the cost-effectiveness of introducing HPV vaccination. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET). The analyses were done from a health system perspective in terms of vaccine delivery routes.

Results

Introduction of bi-valent HPV vaccination was found highly cost-effective (ICER = US$488/DALY) at Gavi (The Vaccine Alliance for Vaccines and Immunizations) negotiated prices. The value of ICERs were US$710, US$356 and US$397 per DALY averted for school-based, health facility-based, and outreach-based programs, respectively, which is consistent with the CET range (US$67 to US$854). However, bivalent and quadrivalent vaccines at listed prices were not found cost-effective, with ICERs of US$1405 and US$3250 per DALY averted, respectively, that exceeds the CETs values.

Conclusions

Introducing a two-dose bi-valent HPV vaccination program is cost-effective in Bangladesh at Gavi negotiated prices. Vaccine price is the dominating parameter for the cost-effectiveness of bivalent and quadrivalent vaccines. Both vaccines are not cost-effective at listed prices in Bangladesh. The evaluation highlights that introducing the two-dose bivalent HPV vaccine at Gavi negotiated prices into a national immunization program in Bangladesh is economically viable to reduce the burden of cervical cancer.

Section snippets

Background

Infection with the human papillomavirus (HPV) is a key cause of cervical cancer (CC), which is a major public health problem worldwide, with morbidity and mortality resulting in 570,000 new cases and 311,000 deaths in 2018, respectively [1]. Approximately 90% of deaths from CC occurred in low and middle-income countries (LMICs) in 2018 [1]. In Bangladesh, approximately 12,000 new cases of CC are detected annually, with the premature death of 6,500 women each year [2], [3].

Most reproductive

Model and methodological assumptions

The study is designed employing a health system perspective using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model. This model was designed and developed by the World Health Organisation (WHO) [10]. It is a user-friendly Excel-based static model to examine the economic viability of vaccinating pre-adolescent girls before their sexual debut. However, this model is not designed to examine other issues such as immunizing males, aged women or the impact of the screening

Results

Table 1 outlines the model parameters and includes: cohort at birth, coverage of vaccination, vaccine effectiveness, the cost of per fully immunized girl (FIG) and delivery costs per FIG. Per episode treatment costs was considered as direct medical and non-medical costs. DALYs were estimated based on non-fatal and fatal cancer episodes and epidemiological data associated with cervical cancer incidence. The female birth cohort size and cohort at vaccination age were 1,574,333 and 1,606,313,

Discussion

To our knowledge, this is the first cost-effectiveness study of introducing a HPV vaccine in Bangladesh. This study aimed to examine the cost-effectiveness of introducing bi-valent and quadrivalent vaccines from health-system perspective. The examination was based on a straightforward model through the three potential vaccine delivery routes. High health care costs and efficient use of available resources demand cost-effectiveness analysis before undertaking any nationwide health program or

Conclusions

This cost-effectiveness exploration demonstrates that introducing a national immunization program of two-dose HPV vaccine for pre-adolescent Bangladeshi girls aged 10 years would be highly cost-effective at Gavi negotiated prices from the health system perspective. Further, this cost-effectiveness was also examined at listed prices for both the bivalent and quadrivalent vaccines, and for various delivery strategies. The results show that a national HPV immunization program in Bangladesh would

Funding

This study was conducted without financial support from any institute or organization.

Author contributions

Conceptualized the study: RAM; Contributed data extraction and analyses: RAM and SAK. Result interpretation: RAM and SAK. Prepared the first draft: RAM and SAK. Contributed during the conceptualization and interpretation of results and substantial revision: RAM, KA, MGH, SAK, ARS, MS, SMSI and JG. Revised and finalized the final draft manuscript: RAM, KA, MGH, SAK, ARS, MS, SMSI and JG. All authors read and approved the final version of the manuscript.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The study was conducted during the first author’s PhD research at the University of Southern Queensland, Australia. This study was conducted without financial support from any institute or organization. Authors would like to gratefully acknowledge the reviewers, Administrative staffs and editors of our manuscript.

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