Projected economic evaluation of the national implementation of a hypothetical HIV vaccination program among adolescents in South Africa, 2012.

Nishila Moodley,Melanie Bertram,Glenda Gray

doi:10.1186/s12889-016-2959-3

Abstract

BackgroundAdolescents in South Africa are at high risk of acquiring HIV. The HIV vaccination of adolescents could reduce HIV incidence and mortality. The potential impact and cost-effectiveness of a national school-based HIV vaccination program among adolescents was determined.MethodThe national HIV disease and cost burden was compared with (intervention) and without HIV vaccination (comparator) given to school-going adolescents using a semi-Markov model. Life table analysis was conducted to determine the impact of the intervention on life expectancy. Model inputs included measures of disease and cost burden and hypothetical assumptions of vaccine characteristics. The base-case HIV vaccine modelled cost at US$ 12 per dose; vaccine efficacy of 50 %; duration of protection of 10 years achieved at a coverage rate of 60 % and required annual boosters. Incremental cost-effectiveness ratios (ICER) were calculated using life years gained (LYG) serving as the outcome measure. Sensitivity analyses were conducted on the vaccine characteristics to assess parameter uncertainty.ResultsThe HIV vaccination model yielded an ICER of US$ 5 per LYG (95 % CI ZAR 2.77–11.61) compared with the comparator, which is considerably less than the national willingness-to-pay threshold of cost-effectiveness. This translated to an 11 % increase in per capita costs from US$ 80 to US$ 89. National implementation of this intervention could potentially result in an estimated cumulative gain of 23.6 million years of life (95 % CI 8.48–34.3 million years) among adolescents age 10–19 years that were vaccinated. The 10 year absolute risk reduction projected by vaccine implementation was 0.42 % for HIV incidence and 0.41 % for HIV mortality, with an increase in life expectancy noted across all age groups. The ICER was sensitive to the vaccine efficacy, coverage and vaccine pricing in the sensitivity analysis.ConclusionsA national HIV vaccination program would be cost-effective and would avert new HIV infections and decrease the mortality and morbidity associated with HIV disease. Decision makers would have to discern how these findings, derived from local data and reflective of the South African epidemic, can be integrated into the national long term health planning should a HIV vaccine become available.

Highlights

Adolescents in South Africa are at high risk of acquiring human immunodeficiency virus (HIV)
The HIV vaccination model yielded an Incremental cost-effectiveness ratios (ICER) of US$ 5 per life years gained (LYG) compared with the comparator, which is considerably less than the national willingness-to-pay threshold of cost-effectiveness
The 10 year absolute risk reduction projected by vaccine implementation was 0.42 % for HIV incidence and 0.41 % for HIV mortality, with an increase in life expectancy noted across all age groups

Summary

Introduction

Adolescents in South Africa are at high risk of acquiring HIV. The HIV vaccination of adolescents could reduce HIV incidence and mortality. The gains made in improving life expectancy are in no small part attributable to ‘the largest antiretroviral (ART) rollout in the world’ that South Africa has managed to achieve [6] To sustain this achievement is no mean feat. While the public sector retention rate approximates 75 % after one year on treatment, South Africa needs to continuously enroll in excess of 500 000 new patients onto ART annually to maintain an ART enrolment ratio exceeding 1.3 [4] This brings into question the long term sustainability of the ART program considering the massive financial and human resource implications the expansion of ART program entails [7]

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