title: Cost-effectiveness of HPV 16, 18 vaccination in Brazil.
abstract: We use an empirically calibrated model to estimate the cost-effectiveness of cervical cancer prevention in Brazil, a country with a high cervical cancer burden. Assuming 70% coverage, HPV 16, 18 vaccination of adolescent girls is expected to reduce the lifetime risk of cancer by approximately 42.7% (range, 33.2-53.5%); screening three times per lifetime is expected to reduce risk by 21.9-30.7% depending on the screening test, and a combined approach of vaccination and screening is expected to reduce cancer risk by a mean of 60.8% (range, 52.8-70.1%). In Brazil; provided the cost per vaccinated woman is less than I$ 25, implying a per dose cost of approximately I$ 5, vaccination before age 12, followed by screening three times per lifetime between ages 35 and 45, would be considered very cost-effective using the country's per capita gross domestic product as a cost-effectiveness threshold. Assuming a coverage rate of 70%, this strategy would be expected to prevent approximately 100,000 cases of invasive cervical cancer over a 5-year period. Vaccination strategies identified as cost-effective may be unaffordable in countries with similar socioeconomic profiles as Brazil without assistance; these results can provide guidance to the global community by identifying health investments of highest priority and with the greatest promise.
authors.affiliation: Department of Health Policy and Management, Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, United States of America. sgoldie@hsph.harvard.edu
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Goldie
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.forename: Katie
authors.initials: K
authors.lastname: Kobus
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
authors.forename: Joshua
authors.initials: J
authors.lastname: Salomon
authors.forename: Meredith K H
authors.initials: MK
authors.lastname: O'shea
authors.forename: F
authors.initials: F
authors.lastname: Xavier Bosch
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000276:immunology*; D052161:Human papillomavirus 18 / Q000276:immunology*; D006801:Humans; D008403:Mass Screening / Q000191:economics; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics* / Q000276:immunology*; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines