Costing and Evaluating Human Papillomavirus (Hpv) Vaccine Strategies in Low- and Middle-Income Countries (Lmics) Utilizing Modeling and Economic Analyses

Abstract

As data to inform evidence-based policy of new and existing HPV vaccination strategies in LMICs are limited, this dissertation focuses on the costing and evaluation of the HPV vaccine utilizing modeling and economic analyses. In Paper 1, we developed a predictive model for estimating standardized immunization delivery unit cost estimates at the country level. The predicted programmatic, economic costs per dose for routine delivery of childhood vaccines was $1.49 (95% uncertainty range: $0.33–4.87) and for HPV vaccines was $2.04 ($0.66–6.20). Country-specific costs modeled within a Bayesian meta-regression framework provide a broad indication of immunization delivery costs that may be preferable to raw country-level data without reliable, standardized review. In Paper 2, we used a multiple modeling approach to estimate the health and economic outcomes associated with HPV vaccine delivery in Uganda, a low-income country in East Africa, where cervical cancer is the leading cause of cancer among females. Using a wide range of plausible scenarios to assess what might be achieved by a campaign delivery strategy for HPV vaccination against HPV-16/18 infections, we found that campaign strategies yielded greater health benefits if campaigns occurred frequently and targeted a wide age range compared with routine HPV vaccination strategies. In Paper 3, relying on the methodology of extended cost-effectiveness analysis (ECEA) to examine the distributional and financial risk protection benefits from HPV vaccination in Ethiopia, we found that routine two-dose HPV vaccination could avert 586,000 cervical cancer deaths and 18,900 cases of catastrophic health expenditure over 2019-2118, assuming 40% vaccination coverage and 100% efficacy against HPV-16/18 with lifelong duration of protection. Approximately 30% of health benefits would accrue to the poorest quintile whereas 66% of financial risk protection benefits accrue to the poorest quintile.