title: Planning for human papillomavirus (HPV) vaccination in sub-Saharan Africa: a modeling-based approach.
abstract: BACKGROUND
  Human papillomavirus (HPV) vaccines have the potential to reduce cervical cancer incidence and mortality, particularly in the parts of the developing world that bear the greatest burden of disease. This research sought to predict the impact and cost-effectiveness of an HPV vaccination program in an example low-resource country with a high burden of cervical cancer: Mali, West Africa.
  
  
  METHODS
  Novel compartmental mathematical models projected the impact of adolescent HPV vaccination in urban and rural areas of Mali. The models accounted for two high-risk vaccine-types: HPV 16 and 18. We then attached comprehensive real cost and cost-effectiveness estimates.
  
  
  RESULTS
  Our models predict that HPV vaccination in Mali will reduce cervical cancer burden by a factor roughly equal to vaccine coverage. A point vaccination program was simulated in a cohort of 333,146 urban and 588,982 rural Malian women, age 10-14. Vaccination of 50% of girls reduced the peak prevalence of HPV 16/18 to 5.0% in the urban setting and 9.6% in the rural setting, down from 11.7% and 22.0%, respectively, with no vaccination. The 50% vaccination scenario averted 1145 cervical cancer deaths in the urban group and 2742 in the rural group. The cost per discounted life-year saved in this scenario was 1030 US dollars (urban) and 725 dollars (rural). The cost per life-year saved was higher at 90% coverage, but was still in the range of a "cost-effective" public health intervention.
  
  
  CONCLUSIONS
  This research yielded the most comprehensive real cost estimates of HPV vaccination yet published for sub-Saharan Africa. Our models indicate that HPV vaccination in Mali will be cost-effective when introduced. To maximize the benefit using limited resources, vaccination programs may begin with a target coverage of about 50%. We anticipate that costs of reaching late adopters after the First Vaccinated Wave of vaccination will be higher, but worthwhile.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States; Department of Medicine, University of Maryland School of Medicine, United States. Electronic address: ktracy@epi.umaryland.edu.
authors.forename: J Kathleen
authors.initials: JK
authors.lastname: Tracy
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Schluterman
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
authors.forename: Christina
authors.initials: C
authors.lastname: Greene
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, United States; Centre Pour Le Developpement Des Vaccins, Mali.
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.affiliation: Department of Biological Sciences, Old Dominion University, United States.
authors.forename: Holly D
authors.initials: HD
authors.lastname: Gaff
mesh_terms: D000293:Adolescent; D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D005544:Forecasting; D006285:Health Planning / Q000191:economics; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D008297:Male; D008302:Mali; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012424:Rural Population; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Compartmental model; Human papillomavirus