Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands; Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands; Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands; Unit of Pharmaco-Therapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands; Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
Vaccine. 2022 Mar 25;40(14):2161-2167. doi: 10.1016/j.vaccine.2022.02.080. Epub 2022 Mar 2.
BACKGROUND: In Ethiopia, cervical cancer is the second most common cancer among women of the reproductive age group. Since 2018, the quadrivalent human papillomavirus (4vHPV) vaccine targeting four HPV types (6/11/16/18) has been introduced in the national immunization program in Ethiopia. Currently, however, a nonavalent HPV (9vHPV) vaccine which provides broader protection against nine HPV types (6/11/16/18/31/33/45/52/58) is available for global use. Our study, therefore, aims to estimate the cost-effectiveness of 9vHPV vaccine compared to the current HPV vaccination program in Ethiopia. METHOD: A static Markov cohort model was used to simulate the progression of HPV infection to cervical cancer for a cohort of 12-years-old girls (N = 100,000) in Ethiopia. The model ran up to the age of 100 years, with a cycle length of 1 year. One-way and probabilistic sensitivity analyses were used to explore the robustness of the model and uncertainties around the parameters included in the model. Cost-effectiveness thresholds of one and three times gross domestic product (GDP) per quality-adjusted life-year (QALY) gained were considered. RESULTS: At a price of US$ 6.9, the incremental cost-effectiveness ratio (ICER) per QALY gained for the 9vHPV vaccine was US$ 454 compared to the 4vHPV vaccine, which is less than one times GDP per capita of Ethiopia. The ICER was most sensitive to the change in the discount rate of QALYs. Compared to 4vHPV vaccine, for 9vHPV vaccine to remain very cost-effective and cost-effective, its price per dose should not exceed US$ 8.4 and US$ 15, respectively, at a threshold of one and three times GDP per capita. CONCLUSION: Compared to the 4vHPV vaccine, the 9vHPV vaccine is a cost-effective option in Ethiopia, given that its price per dose does not exceed US$15.
背景：在埃塞俄比亚，宫颈癌是育龄妇女中第二常见的癌症。自 2018 年以来，四价人乳头瘤病毒（4vHPV）疫苗针对四种 HPV 类型（6/11/16/18）已被纳入埃塞俄比亚国家免疫计划。然而，目前可用于全球的九价 HPV（9vHPV）疫苗提供了针对九种 HPV 类型（6/11/16/18/31/33/45/52/58）的更广泛保护。因此，我们的研究旨在评估 9vHPV 疫苗与埃塞俄比亚目前 HPV 疫苗接种计划相比的成本效益。 方法：使用静态马尔可夫队列模型来模拟埃塞俄比亚 12 岁女孩（N=100,000）人群中 HPV 感染向宫颈癌的进展。该模型的运行时间最长可达 100 岁，每个周期为 1 年。进行了单因素和概率敏感性分析，以探索模型的稳健性以及模型中包含的参数的不确定性。考虑了一至三倍国内生产总值（GDP）每增加一个质量调整生命年（QALY）的成本效益阈值。 结果：以每剂 6.9 美元的价格，9vHPV 疫苗每获得一个 QALY 的增量成本效益比（ICER）为 454 美元，低于埃塞俄比亚人均 GDP 的 1 倍。ICER 对 QALY 贴现率的变化最为敏感。与 4vHPV 疫苗相比，9vHPV 疫苗要保持非常有成本效益和具有成本效益，其每剂价格分别不应超过 8.4 美元和 15 美元，在人均 GDP 的一至三倍阈值下。 结论：与 4vHPV 疫苗相比，9vHPV 疫苗在埃塞俄比亚是一种具有成本效益的选择，前提是其每剂价格不超过 15 美元。
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