The projected cost-effectiveness and budget impact of HPV vaccine introduction in Ghana.

Autor: Vodicka E; PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98109, USA. Electronic address: evodicka@path.org., Nonvignon J; University of Ghana, Department of Health Policy, Planning and Management, P.O Box LG 78, Legon, Accra, Ghana., Antwi-Agyei KO; PATH-Ghana, 14a Ameda Street, Roman Ridge, Accra, Ghana., Bawa J; PATH-Ghana, 14a Ameda Street, Roman Ridge, Accra, Ghana., Clark A; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom., Pecenka C; PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98109, USA., LaMontagne DS; PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98109, USA.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2022 Mar 31; Vol. 40 Suppl 1, pp. A85-A93. Date of Electronic Publication: 2021 Jul 21.
DOI: 10.1016/j.vaccine.2021.07.027
Abstrakt: Background: Cervical cancer is responsible for around one-quarter of all cancer deaths among Ghanaian women. Between 2013 and 2015, Ghana conducted a pilot of HPV vaccination among 10-14-year-old girls in four regions; however, the country has yet to introduce the vaccine nationally. This study projected the cost-effectiveness and budget impact of adding HPV vaccination into Ghana's national immunization program.
Methods: We used a proportional outcomes model (UNIVAC, version 1.4) to evaluate the cost-effectiveness of introduction with bivalent (Cervarix™) and quadrivalent (Gardasil®) vaccines from government and societal perspectives. Vaccine introduction was modeled to start in 2022 and continue over ten birth cohorts using a combined delivery strategy of school (80%) and community outreach (20%). We modeled vaccination in a single age cohort of 9-year-old girls vs. a multi-age cohort of 9-year-old girls (routine) and 10-14-year-old girls (one-time campaign) compared to no vaccination. Health outcomes included cervical cancer cases, hospitalizations, deaths, and disability-adjusted life years (DALYs). We applied a discount rate of 3% to costs and outcomes. All monetary units are reported in USD 2018.
Results: National HPV vaccination in Ghana was projected to be cost-effective compared to no vaccination in all scenarios evaluated. The most cost-effective and dominant strategy was vaccination among 9-year-old girls, plus a one-time campaign among 10-14-year-old with the bivalent vaccine ($158/DALY averted from the government perspective; 95% credible range: $19-$280/DALY averted). Projected average annual costs of the vaccine program ranged from $11.2 to $15.4 M, depending on strategy. This represents 11-15% of the estimated total immunization costs for 2022 ($100,857,875 based on Ghana's comprehensive Multi-Year Plan for Immunization, 2020-2024).
Discussion: Our model suggests that introducing HPV vaccination would be cost-effective in Ghana under any strategy when willingness-to-pay is at least 40% GDP per capita ($881). Inclusion of a one-time catch-up campaign is shown to create greater value for money than routine immunization alone but would incur greater program costs.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Justice Nonvignon received consulting fees from PATH for this work. There are no other interests to declare.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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