Impact and Cost-Effectiveness of Alternative Human Papillomavirus Vaccines for Preadolescent Girls in Mozambique: A Modelling Study
Esperança Lourenço Guimarães,
Assucênio Chissaque,
Clint Pecenka,
Frédéric Debellut,
Anne Schuind,
Basília Vaz,
Arlindo Banze,
Ricardina Rangeiro,
Arlete Mariano,
Cesaltina Lorenzoni,
Carla Carrilho,
Maria do Rosário Oliveira Martins,
Nilsa de Deus,
Andrew Clark
Affiliations
Esperança Lourenço Guimarães
Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila—Parcela N° 3943, Maputo 1120, Mozambique
Assucênio Chissaque
Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila—Parcela N° 3943, Maputo 1120, Mozambique
Clint Pecenka
Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
Frédéric Debellut
Center for Vaccine Innovation and Access, PATH, 1202 Geneva, Switzerland
Anne Schuind
Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
Basília Vaz
Ministry of Health, Maputo 1008, Mozambique
Arlindo Banze
Ministry of Health, Maputo 1008, Mozambique
Ricardina Rangeiro
National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
Arlete Mariano
National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
Cesaltina Lorenzoni
National Cancer Control Program, Hospital Central de Maputo, Maputo 1101, Mozambique
Carla Carrilho
Department of Pathology, Universidade Eduardo Mondlane, Maputo 3453, Mozambique
Maria do Rosário Oliveira Martins
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Junqueira Street 100, 1349-008 Lisbon, Portugal
Nilsa de Deus
Instituto Nacional de Saúde, Marracuene District, EN1, Bairro da Vila—Parcela N° 3943, Maputo 1120, Mozambique
Andrew Clark
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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.
