Cost-effectiveness of the introduction of two-dose bi-valent (Cervarix) and quadrivalent (Gardasil) HPV vaccination for adolescent girls in Bangladesh |
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| Institution: | 1. Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland 4350, Australia;2. School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350, Australia;3. Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh;4. Health and Epidemiology Research, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh;5. School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban 4000, South Africa;6. Economics Discipline, Social Science School, Khulna University, Khulna 9208, Bangladesh;7. School of Health & Social Development, Deakin University, Melbourne, Australia;8. Bangladesh Institute of Development Studies (BIDS), Dhaka 1212, Bangladesh;9. Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia;1. Public Health Ontario, Canada;2. University of Toronto, Canada;3. Institute for Clinical Evaluative Sciences, Toronto, Canada;4. Toronto Health Economics and Technology Assessment Collaborative, Canada;5. Cancer Care Ontario, Canada;6. University Health Network, Toronto, Canada;1. Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands;2. Department of Medical Microbiology, Tumor Virology and Cancer Immunotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;3. Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;4. Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;1. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia;2. Tartu University Hospital, Women''s Clinic, Tartu, Estonia;3. Institute of Social Studies, University of Tartu, Tartu, Estonia;1. Department of Public Health, University of Otago, Wellington, New Zealand;2. MSc Programme in Health Economics, University of York, United Kingdom;3. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia;1. Stapleton Lane Clinic, St John''s, Antigua, West Indies;2. Pan American Health Organization, Washington, D.C., USA;3. London School of Hygiene & Tropical Medicine, London, UK;4. Ministry of Health, Belmopan, Belize;2. Rio de Janeiro State University, Social Medicine Institute, Rio de Janeiro, RJ, Brazil;3. Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiania, GO, Brazil;4. Leonor Mendes de Barros Maternity Hospital, Health State Secretariat, São Paulo, SP, Brazil;6. Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom;7. Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States |
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| Abstract: | BackgroundCervical 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.MethodsThe 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.ResultsIntroduction 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.ConclusionsIntroducing 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. |
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| Keywords: | Human papillomavirus Bi-valent and quadrivalent vaccines Cost-effectiveness analysis Incremental cost-effectiveness ratios Disability-adjusted life years Bangladesh |
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