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Cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination in South Africa

Michaeli, Daniel Tobias, Stoycheva, Sophia, Marcus, Simon Mashudu, Zhang, Wenjia, Michaeli, Julia Caroline and Michaeli, Thomas (2022) Cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination in South Africa. Clinical Drug Investigation, 42 (4). 333 - 343. ISSN 1173-2563

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Identification Number: 10.1007/s40261-022-01138-6


Background and Objectives: In South Africa, the prevalence of human papillomavirus (HPV) and associated diseases, such as cervical cancer and genital warts, is among the highest in the world. This study evaluates the cost-effectiveness of bivalent, quadrivalent, and nonavalent HPV vaccination for 9- to 14-year-old girls from the South African healthcare system perspective. Methods: A Markov model portraying the natural HPV disease progression from high-risk infection to cervical intraepithelial neoplasia (CIN) I, CIN II/III, or cervical cancer and from low-risk infection to genital warts was built. Transition probability, utility, and efficacy data were sourced from peer-reviewed literature. Vaccination costs were calculated based on the World Health Organization (WHO) guidelines. The model was populated with a cohort of 520,000 9-year-old girls to calculate incremental cost-effectiveness ratios (ICER) in South African Rand (R) per quality-adjusted life-years (QALYs) gained for each vaccination strategy. Results: All HPV vaccination strategies dominate the no vaccine strategy. Compared with the bivalent vaccine, the nonavalent strategy increases QALYs by 0.14 and costs by R1793 (ICER: R13,013 per QALY) per person, while the quadrivalent vaccination provides −0.02 incremental QALYs and R1748 costs (ICER: −R116,397 per QALY). Consequently, at the South African willingness-to-pay threshold of R23,630 per QALY, nonavalent vaccination is the preferred strategy, with a probability of 90.2%. Scenario analysis demonstrated that results are influenced by vaccine coverage, efficacy, and duration of efficacy. Conclusions: The introduction of nonavalent for bivalent HPV vaccination is a cost-effective intervention in South Africa. HPV vaccination should be part of a multifaceted public health strategy entailing screening, condoms, and education of all stakeholders to reduce the significant burden of sexual transmitted diseases in South Africa. Sex-neutral and catch-up vaccinations are subjects for further research.

Item Type: Article
Official URL:
Additional Information: © 2022 The Authors
Divisions: Health Policy
Subjects: R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
R Medicine > RM Therapeutics. Pharmacology
Date Deposited: 30 Mar 2022 09:57
Last Modified: 17 Apr 2024 21:12

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