Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru / Repercusiones sanitarias y económicas de la vacunación de niñas preadolescentes contra los tipos 16 y 18 del virus del papiloma humano y el tamizaje del cáncer cervicouterino en las mujeres adultas en el Perú

OBJECTIVE: To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e.g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program. METHODS: Evidence (e.g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs. RESULTS: Status quo low levels of screening (e.g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at ~US$ 7/dose or ~US$ 1 300 at ~US$ 20/dose. One year of vaccination was estimated to cost ~US$ 5 million at ~US$ 5/dose or ~US$ 16 million at ~US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective. CONCLUSIONS: Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.

OBJETIVO: Calcular los beneficios, la rentabilidad (relación costo-efectividad), y los costos financieros (asequibilidad) de añadir la vacunación contra el virus del papiloma humano (VPH) al programa de tamizaje del cáncer cervicouterino en el Perú. MÉTODOS: Se combinaron los datos probatorios (por ejemplo, cobertura, costos de prestación) de un proyecto piloto de vacunación contra el VPH llevado a cabo en el Perú con datos epidemiológicos, en un modelo matemático calibrado empíricamente para evaluar el tamizaje (prueba de ADN del VPH tres a cinco veces durante toda la vida) y la vacunación contra el VPH, según diferentes supuestos de costo, cobertura y eficacia. Los resultados del modelo incluían la reducción del riesgo de cáncer durante toda la vida, los casos de cáncer evitados, las vidas salvadas, los incrementos de la esperanza media de vida, los costos financieros a corto plazo y los costos económicos a largo plazo actualizados. RESULTADOS: Los bajos niveles de tamizaje actuales (cobertura del tamizaje citológico de 10,0 %) redujeron en 11,9 % el riesgo de cáncer cervicouterino durante toda la vida en comparación con la ausencia de tamizaje. La adición de la vacunación de las niñas preadolescentes con la cobertura alcanzada en el programa piloto (82,0 %) produjo una reducción adicional de 46,1 % y costaría menos de US$ 500 por cada año de vida salvado a US$ 7 la dosis, o de US$ 1 300 a US$ 20 la dosis. Se calculó que el costo de las vacunaciones de un año era aproximadamente de US$ 5 millones a unos US$ 5 la dosis o de aproximadamente US$ 16 millones a unos US$ 20 la dosis, incluidos los costos programáticos. La mejora del tamizaje en las mujeres adultas combinada con la vacunación de las preadolescentes mostraba cocientes de rentabilidad incremental inferiores al producto interno bruto per cápita del Perú en el año 2005 (PIB US$ 2 852, en dólares del 2009), y se consideraría rentable. CONCLUSIONES: La vacunación de las preadolescentes contra el VPH, junto con la mejora del tamizaje mediante la prueba de ADN del VPH en las mujeres adultas, podría prevenir dos de cada tres muertes debidas a cáncer cervicouterino. Varias estrategias se considerarían rentables en relación con los recursos invertidos, a condición de que el precio de la vacuna sea bajo. Aunque los costos financieros implican inversiones inmediatas sustanciales, el valor elevado de los beneficios debe motivar la elaboración de mecanismos creativos para financiar y extender los programas de prestación de servicios.

Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru.

OBJECTIVE: To estimate the benefits, cost-effectiveness (i.e., value for money), and required financial costs (e.g., affordability) of adding human papillomavirus (HPV) vaccination to Peru's cervical cancer screening program. METHODS: Evidence (e.g., coverage, delivery costs) from an HPV vaccination demonstration project conducted in Peru was combined with epidemiological data in an empirically calibrated mathematical model to assess screening (HPV DNA testing three to five times per lifetime) and HPV vaccination under different cost, coverage, and efficacy assumptions. Model outcomes included lifetime risk of cancer reduction, cancer cases averted, lives saved, average life expectancy gains, short-term financial costs, and discounted long-term economic costs. RESULTS: Status quo low levels of screening (e.g., cytologic screening at 10.0% coverage) reduced lifetime risk of cervical cancer by 11.9%, compared to not screening. Adding vaccination of preadolescent girls at a coverage achieved in the demonstration program (82.0%) produced an additional 46.1% reduction, and would cost less than US$ 500 per year of life saved (YLS) at ~US$ 7/dose or ~US$ 1 300 at ~US$ 20/dose. One year of vaccination was estimated to cost ~US$ 5 million at ~US$ 5/dose or ~US$ 16 million at ~US$ 20/dose, including programmatic costs. Enhanced screening in adult women combined with preadolescent vaccination had incremental cost-effectiveness ratios lower than Peru's 2005 per capita gross domestic product (GDP; US$ 2 852, in 2009 US$), and would be considered cost-effective. CONCLUSIONS: Preadolescent HPV vaccination, followed by enhanced HPV DNA screening in adult women, could prevent two out of three cervical cancer deaths. Several strategies would be considered "good value" for resources invested, provided vaccine prices are low. While financial costs imply substantial immediate investments, the high-value payoff should motivate creative mechanisms for financing and scale-up of delivery programs.