Potential health impact and cost-effectiveness of bivalent human papillomavirus (HPV) vaccination in Afghanistan

Palwasha Anwari,Frédéric Debellut,Elisabeth Vodicka,Andrew Clark,Farhad Farewar,Zubiada A Zhwak,Dastagger Nazary,Clint Pecenka,D Scott Lamontagne,Najibullah Safi

doi:10.1016/j.vaccine.2019.12.013

Abstract

IntroductionHuman papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making. MethodAn Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. We also explored a scenario with a catch-up campaign for girls aged 10–14 years. Input parameters were based on local sources, published literature, or assumptions when no data was available. The primary outcome measure was the discounted cost per disability-adjusted life-year (DALY) averted, evaluated from both government and societal perspectives. ResultsVaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort. The incremental cost-effectiveness ratio was US$426 per DALY averted from the government perspective and US$400 per DALY averted from the societal perspective. The estimated annual cost of the HPV vaccination program (US$3,343,311) represents approximately 3.53% of the country′s total immunization budget for 2018 or 0.13% of total health expenditures. ConclusionIn Afghanistan, HPV vaccine introduction targeting a single cohort is potentially cost-effective (0.7 times the GDP per capita of $586) from both the government and societal perspective with additional health benefits generated by a catch-up campaign, depending on the government′s willingness to pay for the projected health outcomes.

Highlights

Human papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia
A multidisciplinary team of experts from the National Immunization Advisory Group (NITAG); the Health Economics and Financing Directorate (HEFD); the Reproductive, Maternal, Neonatal, Child and Adolescent Health Directorate (RMNCAH); the National Expanded Program on Immunization (NEPI); the National Cancer Control Program (NCCP); and the World Health Organization (WHO) country office in Afghanistan carried out this study with support of PATH and London School of Hygiene and Tropical Medicine (LSHTM)
The UNIVAC model estimated that, without vaccination, 4026 cervical cancer cases, 281 hospitalizations, 3678 deaths, and 17,919 disability-adjusted life-year (DALY) would occur in the lifetime of a single cohort of girls aged 9 years old

Summary

Introduction

Human papillomavirus (HPV) vaccination has not been introduced in many countries in South-Central Asia, including Afghanistan, despite the sub-region having the highest incidence rate of cervical cancer in Asia. This study estimates the potential health impact and cost-effectiveness of HPV vaccination in Afghanistan to inform national decision-making. Method: An Excel-based static cohort model was used to estimate the lifetime costs and health outcomes of vaccinating a single cohort of 9-year-old girls in the year 2018 with the bivalent HPV vaccine, compared to no vaccination. Results: Vaccinating a single cohort of 9-year-old girls against HPV in Afghanistan could avert 1718 cervical cancer cases, 125 hospitalizations, and 1612 deaths over the lifetime of the cohort.

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Discussion

Conclusion