Natunen K, Lehtinen TA, Torvinen S and Lehtinen M
Background: Prophylactic human papilloma virus (HPV) vaccines represent a promising option for cervical
cancer (CC) prevention in countries where screening, diagnostics and treatment have difficulties in producing
significant reductions in CC incidence/mortality. Numerous studies have evaluated the cost-effectiveness of HPV vaccination strategies including female vaccination alone, female vaccination combined with different screening strategies, or female and male vaccination. Countries with the highest CC incidences, however, have the least resources to implement any CC prevention programs. To understand priorities in low vs. middle income countries with high CC incidence pertinent cost-efficacy studies on CC interventions were compared.
Methods: We conducted a systematic review of cost-effectiveness studies including only countries with high CC incidence (>14.5) and GDP per capita below the high income group (<37,162 2010 international $).
Results: We identified 16 cost-effectiveness studies (with the bivalent 16/18 or the quadrivalent 6/11/16/18
vaccine) including 25 countries from Europe, Africa, Latin America, and Asia. CC incidence ratios vary from 14.8 (Kenya) to 38.3 (Mozambique) and GDP per capita from 913 (Mozambique) I$ to 27063 I$ (Slovenia). High income countries that met the high CC incidence criteria included Ireland (14.7) and Denmark (18.4). Sub-Saharan African countries excluded, the CC incidence rates were comparable in the middle- and low-income countries (median 18.5 vs. 22). All of the studies concluded that HPV vaccination of females is very effective, especially combined with a screening, and cost-effective assuming a low to moderate vaccine price at the same time underlining that the commonly used cost-effectiveness thresholds do not always equal affordability.
Conclusion: Our systematic review showed that HVP vaccination alone or combined with screening strategies is cost-effective in countries with high CC incidence and moderate to low GDP per capita. Affordability of the vaccination program is a crucial determinant for the success of cervical cancer prevention by country, and determines whether rapidly increasing differences between the middle-and low-income countries in HPV disease burden are imminent in the future.