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

• Published in: Vaccine Vol. 38; no. 2; pp. 165 - 172
• Main Authors: Mahumud, Rashidul Alam, Gow, Jeff, Alam, Khorshed, Keramat, Syed Afroz, Hossain, Md Golam, Sultana, Marufa, Sarker, Abdur Razzaque, Islam, Sheikh M. Shariful
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 10.01.2020; Elsevier Limited
• Subjects: Adolescent; Adolescents; Bangladesh; Bi-valent and quadrivalent vaccines; Cancer; Cellular biology; Cervical cancer; Cervix; Cost analysis; Cost-Benefit Analysis; Cost-effectiveness analysis; Disability-adjusted life years; Discount rates; Drug delivery systems; Economic impact; Economic models; Evaluation; Female; GDP; Girls; Gross Domestic Product; Health care facilities; Health facilities; Human papillomavirus; Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 - administration & dosage; Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 - economics; Humans; Immunization; Immunization Programs - economics; Incremental cost-effectiveness ratios; Intervention; Models, Economic; Mortality; Papillomavirus Infections - economics; Papillomavirus Infections - prevention & control; Papillomavirus Vaccines - administration & dosage; Papillomavirus Vaccines - economics; Prices; Public health; Quality-Adjusted Life Years; Uterine Cervical Neoplasms - prevention & control; Vaccination - economics; Vaccination - methods; Vaccines; Womens health; Bangladesh; United States > US; Cost-effectiveness analysis; Human papillomavirus; Bangladesh; Disability-adjusted life years; Bi-valent and quadrivalent vaccines; Incremental cost-effectiveness ratios
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2019.10.037

•These 4vHPV and 2vHPV vaccines evaluation considered health system perspective.•The bivalent vaccination was found to be cost-effective at Gavi-negotiated prices in Bangladesh.•This vaccine offers substantial future benefits for preadolescents in Bangladesh. 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. 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. 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. 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.