Work

Impact, cost-effectiveness, and budget implications of HPV vaccination in Kenya: A modelling study

Year: 2023

Type: article

Abstract: Background: Sub-Saharan Africa has the highest rate of cervical cancer cases and deaths worldwide. Kenya introduced a quadrivalent HPV vaccine (GARDASIL-4©) for ten-year-old girls in late 2019 with donor support from Gavi, the Vaccine Alliance (Gavi). As Kenya may soon graduate from Gavi support, it is important to evaluate the potential budget impact and cost-effectiveness of this vaccine and available alternatives. Methods: We used the UNIVAC decision support model (static proportionate outcomes model) to evaluate the potential impact and cost-effectiveness of introducing HPV vaccination for ten-year-old Kenyan girls over a ten-year period (2020–2029). We included a catch-up campaign for girls aged 11–14 years in the year 2020. We estimated the number of cervical cancer cases, deaths, disability adjusted life years (DALYs), and healthcare costs (government and societal perspective) expected to occur with and without vaccination over the lifetimes of each cohort of vaccinated girls. For each of the four products available globally (CECOLIN©, CERVARIX©, GARDASIL-4©, and GARDASIL-9 ©), we estimated the cost (2021 US$) per DALY averted compared to no vaccine and to each other. Model inputs were obtained from local and global published sources, as well as local stakeholders.Results: We estimated around 320,000 cases and 225,000 deaths attributed to cervical cancer would occur over the lifetimes of the 14 evaluated birth cohorts. HPV vaccination could reduce this burden by 42–60%. Without cross-protection, CECOLIN has the lowest net cost and most attractive cost effectiveness ($3 per DALY averted from a government perspective and cost-saving from a societal perspective). With cross-protection, CERVARIX would be the most cost-effective option (cost-saving from either a government or societal perspective). Both options (CECOLIN without cross-protection and CERVARIX with cross-protection) would have a 100% probability of being cost-effective at a willingness81 to-pay threshold set at $100 (5% of Kenya’s national gross domestic product per capita) when compared to no vaccination. Should Kenya reach its target of 90% coverage and graduate from Gavi support, the undiscounted vaccine program cost could exceed US$ 10 million per year. For all three vaccines currently supported by Gavi, adoption of a single-dose strategy would be cost-saving compared to no vaccination. Conclusion: HPV vaccination is a highly cost-effective intervention for Kenyan girls. Compared to the HPV vaccine currently used in Kenya, alternative products could provide similar or greater health benefits at lower net costs and are therefore worth serious consideration. Substantial government funding will be required to reach ambitious coverage targets and sustain the program as Kenya graduates from Gavi support. A one-dose strategy has demonstrated similar impact to a two-dose strategy in Kenyan girls and provides one option for reducing the cost of the HPV vaccination program going forward.

Source: Vaccine

DOI: 10.1016/j.vaccine.2023.05.019