Luvsan Munkh-Erdene, Vodicka Elisabeth, Jugder Uranbolor, Tudev Undarmaa, Clark Andy, Groman Devin, Otgonbayar Dashpagam, Demberelsuren Sodbayar, LaMongtagne D Scott, Pecenka Clint
Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Rm. 334. Sukhbaatar District, S.Zorig Street, Ulaanbaatar, Mongolia.
PATH, Seattle, WA, USA.
Vaccine X. 2022 Apr 8;11:100161. doi: 10.1016/j.jvacx.2022.100161. eCollection 2022 Aug.
Cervical cancer is a leading cause of cancer among women in Mongolia with an age-standardized incidence rate of 23.5 per 100,000. HPV vaccination has not been introduced nationally and Gavi co-financing support is not available in Mongolia. Extended Gavi pricing for HPV vaccine may be available from vaccine manufacturers for a number of years. To inform introduction decision-making, we evaluated the potential cost-effectiveness of HPV vaccination among girls and young women in Mongolia.
We used UNIVAC (version 1.4), a static decision model, to evaluate the health and economic outcomes of single-cohort vaccination among females from the government perspective compared to no vaccination. We modeled vaccine introduction over 10 birth cohorts starting in 2022 comparing quadrivalent or bivalent vaccine selection and vaccine pricing variations. We used locally-specific data for cancer incidence, mortality, treatment and costs. Model outcomes included cancer cases, hospitalizations, deaths, disability-adjusted life years (DALY), and costs presented in 2018 USD. Incremental costs and health outcomes were discounted at 3% and aggregated into an Incremental Cost-Effectiveness Ratio (ICER).
The base-case scenario of HPV vaccination among 9 year-old girls was projected to avert 5,692 cervical cancer cases, 3,240 deaths, and 11,886 DALYs and incur $2.4-3.1M more costs compared to no vaccination. At prices of ($4.50-$4.60/dose), we estimated an ICER of $166-$265/DALY averted among 9-year-olds. When price per dose was increased to reported mean vaccine purchase price for non-Gavi LMICs ($14.17/dose), the ICER ranged from $556-820/DALY averted.
HPV vaccination among girls is highly likely to be a cost-effective investment in Mongolia compared to no vaccination with projected ICERs less than 20% of the 2018 GDP per capita of $3,735.
宫颈癌是蒙古女性癌症的主要病因，年龄标准化发病率为每10万人23.5例。蒙古尚未在全国范围内引入人乳头瘤病毒（HPV）疫苗接种，且该国无法获得全球疫苗免疫联盟（Gavi）的共同融资支持。HPV疫苗的Gavi扩展定价可能在数年内由疫苗制造商提供。为了为引入决策提供信息，我们评估了蒙古女孩和年轻女性中HPV疫苗接种的潜在成本效益。
我们使用静态决策模型UNIVAC（1.4版），从政府角度评估单队列接种疫苗与不接种疫苗相比的健康和经济结果。我们模拟了从2022年开始的10个出生队列的疫苗引入情况，比较了四价或二价疫苗的选择以及疫苗定价变化。我们使用了当地特定的癌症发病率、死亡率、治疗和成本数据。模型结果包括癌症病例、住院治疗、死亡、伤残调整生命年（DALY）以及以2018年美元表示的成本。增量成本和健康结果按3%进行贴现，并汇总为增量成本效益比（ICER）。
预计9岁女孩接种HPV疫苗的基本情况与不接种疫苗相比，可避免5692例宫颈癌病例、3240例死亡和11886个DALY，并产生多240万至310万美元的成本。在每剂（4.50 - 4.60美元）的价格下，我们估计9岁女孩每避免一个DALY的ICER为166 - 265美元。当每剂价格提高到报告的非Gavi低收入和中等收入国家的平均疫苗购买价格（每剂14.17美元）时，ICER范围为每避免一个DALY 556 - 820美元。
与不接种疫苗相比，在蒙古女孩中接种HPV疫苗很可能是一项具有成本效益的投资，预计ICER低于2018年人均国内生产总值3735美元的20%。
