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
Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila-Parcela N° 3943, Maputo 1120, Mozambique.
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Junqueira Street 100, 1349-008 Lisbon, Portugal.
Vaccines (Basel). 2023 Jun 2;11(6):1058. doi: 10.3390/vaccines11061058.
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.
莫桑比克是世界上宫颈癌发病率最高的国家之一。人乳头瘤病毒（HPV）疫苗接种于2021年引入。本研究评估了当前HPV疫苗（以下简称加德西-4）以及未来可能使用的其他两种疫苗（CECOLIN和希瑞适）对健康和经济的影响。采用静态队列模型来估计2022年至2031年期间在莫桑比克为女孩接种疫苗的成本和收益。主要结局指标是从政府角度来看避免每一个伤残调整生命年的增量成本。我们进行了确定性和概率性敏感性分析。在没有交叉保护的情况下，所有三种疫苗均可避免约54%的宫颈癌病例和死亡。在有交叉保护的情况下，希瑞适可避免70%的病例和死亡。在没有全球疫苗免疫联盟（Gavi）支持的情况下，贴现后的疫苗计划成本在6000万美元至8100万美元之间。在Gavi支持下，所有疫苗的疫苗计划成本约为3700万美元。在没有交叉保护的情况下，CECOLIN占主导地位，无论有无Gavi支持都具有成本效益。在有交叉保护和Gavi支持的情况下，希瑞适占主导地位且节省成本。在有交叉保护且没有Gavi支持的情况下，CECOLIN具有最有利的成本效益比。结论：在设定为人均国内生产总值（GDP）35%的支付意愿（WTP）阈值下，HPV疫苗接种在莫桑比克具有成本效益。最佳疫苗选择取决于交叉保护假设。
