Autor(es):
Guimarães, Esperança Lourenço ; Chissaque, Assucênio ; Pecenka, Clint ; Debellut, Frédéric ; Schuind, Anne ; Vaz, Basília ; Banze, Arlindo ; Rangeiro, Ricardina ; Mariano, Arlete ; Lorenzoni, Cesaltina ; Carrilho, Carla ; Martins, Maria do Rosário Oliveira ; de Deus, Nilsa ; Clark, Andrew
Data: 2023
Identificador Persistente: http://hdl.handle.net/10362/157227
Origem: Repositório Institucional da UNL
Assunto(s): cervical cancer; cost-effectiveness; modelling; Mozambique; papillomavirus; UNIVAC; vaccination; QR180 Immunology; RJ101 Child Health. Child health services; RC0254 Neoplasms. Tumors. Oncology (including Cancer); RM Therapeutics. Pharmacology; Immunology; Pharmacology; Drug Discovery; Infectious Diseases; Pharmacology (medical); Pediatrics, Perinatology, and Child Health; SDG 3 - Good Health and Well-being; SDG 10 - Reduced Inequalities
Descrição
Funding Information: This work was supported, in part, by the Bill and Melinda Gates Foundation, through PATH subaward number: GAT.2111-01707508-SUB. Under the grant conditions of the foundation, a Creative Commons Attribution 4.0 generic license has already been assigned to the author accepted manuscript version that might arise from this submission. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill and Melinda Gates Foundation. Publisher Copyright: © 2023 by the authors.
Mozambique has one of the highest rates of cervical cancer in the world. Human papillomavirus (HPV) vaccination was introduced in 2021. This study evaluated the health and economic impact of the current HPV vaccine (GARDASIL® hereafter referred to as GARDASIL-4) and two other vaccines (CECOLIN® and CERVARIX®) that could be used in the future. A static cohort model was used to estimate the costs and benefits of vaccinating girls in Mozambique over the period 2022–2031. The primary outcome measure was the incremental cost per disability-adjusted life-year averted from a government perspective. We conducted deterministic and probabilistic sensitivity analyses. Without cross-protection, all three vaccines averted approximately 54% cervical cancer cases and deaths. With cross-protection, CERVARIX averted 70% of cases and deaths. Without Gavi support, the discounted vaccine program costs ranged from 60 million to 81 million USD. Vaccine program costs were approximately 37 million USD for all vaccines with Gavi support. Without cross-protection, CECOLIN was dominant, being cost-effective with or without Gavi support. With cross-protection and Gavi support, CERVARIX was dominant and cost-saving. With cross-protection and no Gavi support, CECOLIN had the most favorable cost-effectiveness ratio. Conclusions: At a willingness-to-pay (WTP) threshold set at 35% of Gross Domestic Product (GDP) per capita, HPV vaccination is cost-effective in Mozambique. The optimal vaccine choice depends on cross-protection assumptions.
