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Abstract
BackgroundWorld Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered. We therefore aimed to evaluate cost-effectiveness of HPV vaccination in Nigeria using pragmatic parameter estimates for cost and programme coverage, i.e. realistically achievable in the studied context.MethodsA microsimulation frame-work was used. The natural history for cervical cancer disease was remodelled from a previous Nigerian model-based study. Costing was based on health providers’ perspective. Disability adjusted life years attributable to cervical cancer mortality served as benefit estimate. Suitable policy option was obtained by calculating the incremental costs-effectiveness ratio. Probabilistic sensitivity analysis was used to assess parameter uncertainty. One-way sensitivity analysis was used to explore the robustness of the policy recommendation to key parameters alteration. Expected value of perfect information (EVPI) was calculated to determine the expected opportunity cost associated with choosing the optimal scenario or strategy at the maximum cost-effectiveness threshold.ResultsCombination of the current scenario of opportunistic screening and national HPV vaccination programme (CS + NV) was the only cost-effective and robust policy option. However, CS + NV scenario was only cost-effective so far the unit cost of HPV vaccine did not exceed $5. EVPI analysis showed that it may be worthwhile to conduct additional research to inform the decision to adopt CS + NV.ConclusionsNational HPV vaccination combined with opportunist cervical cancer screening is cost-effective in Nigeria. However, adoption of this strategy should depend on its relative efficiency when compared to other competing new vaccines and health interventions.
Highlights
World Health Organisation recommends routine Human Papilloma Virus (HPV) vaccination for girls when its cost-effectiveness in the country or region has been duly considered
Analysis We identified the suitable cervical cancer prevention policy in Nigeria by calculating the incremental costseffectiveness ratio (ICER)
The first policy question assessed whether a national HPV vaccination programme should be added to the current scenario of opportunistic cervical cancer screening (CS + National vaccination (NV)) or to a national screening programme (NS + NV)
Summary
Overview of competing strategies The following cervical cancer prevention strategies were considered: Current scenario of opportunistic screening (CS) – The ‘current scenario’ depicts the existing situation in Nigeria where cervical cancer screening is opportunistic and funded ‘out of pocket’. Cost of treating CIN 1, CIN 2/3, and CC were obtained from the previous Nigerian model-based study [9]. The Nigerian model-based study (conducted in 2011) estimated the different treatment costs from a retrospective chart review performed at the University College Hospital at Ibadan, Nigeria. Costs of cervical cancer screening with VIA and cryotherapy were obtained from a Ghanaian study [24] and were inflated to 2015 US$ value using a web-based CPI inflation calculator [25]. AVaccine procurement cost was modified to reflect the cost of two doses at US$4.5 per dose instead of three doses at US$5 as per original study intensity, higher screening coverage, and higher or lower vaccination coverage on policy recommendation were explored using one-way sensitivity analysis.
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