Cost-effectiveness of HPV vaccination in Belize.
OBJECTIVE
Among women in Belize, cervical cancer is both the leading cancer and the leading cause of cancer deaths. Both the quadrivalent and bivalent human papillomavirus (HPV) vaccines are licensed in Belize. The Ministry of Health of Belize convened a multidisciplinary team to estimate the costs, health benefits, and cost-effectiveness of adding an HPV vaccine to the national immunization schedule.


METHODS
The CERVIVAC cost-effectiveness model (Version 1.123) was used to assess the lifetime health and economic outcomes of vaccinating one cohort of girls aged 10 years against HPV. The comparator was no HPV vaccination. The PAHO Revolving Fund negotiated price of US$ 13.79 per dose was used (for the quadrivalent vaccine) and national data sources were used to define demography, cervical cancer incidence and mortality, cervical cancer treatment costs, and vaccine delivery costs. Estimates from international agencies were used in scenario analysis.


RESULTS
In a cohort of ∼4000 Belizean girls tracked over a lifetime, HPV vaccination is estimated to prevent 69 new cases of cervical cancer (undiscounted), and 51 cervical cancer deaths (undiscounted). Considering the potential cervical cancer treatment costs and lost wages avoided by households (societal perspective), the cost per disability-adjusted life year (DALY) averted was estimated to be US$ 429. This increased to US$ 1320 when cervical cancer treatment costs and lost wages were excluded from the analysis. Both estimates are far below the gross domestic product (GDP) per capita of Belize (US$ 4795). The lifetime health care costs saved by the women and their families represent more than 60% of the investment cost needed by the Government for the vaccine.


CONCLUSIONS
Routine HPV vaccination would be highly cost-effective in Belize. If affordable, efforts should be made to expedite the introduction of this vaccine into the Belizean national immunization program.
Stapleton Lane Clinic, St John's, Antigua, West Indies. Electronic address: lesliewalwyn@gmail.com.
Leslie
L
Walwyn
Pan American Health Organization, Washington, D.C., USA.
Cara Bess
CB
Janusz
London School of Hygiene & Tropical Medicine, London, UK.
Andrew David
AD
Clark
Pan American Health Organization, Washington, D.C., USA.
Elise
E
Prieto
Ministry of Health, Belmopan, Belize.
Eufemia
E
Waight
Ministry of Health, Belmopan, Belize.
Natalia
N
Largaespada
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001531:Belize / Q000453:epidemiology; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18 / Q000008:administration & dosage / Q000191:economics* / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D030361:Papillomavirus Infections / Q000150:complications / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D002583:Uterine Cervical Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics* / Q000379:methods; D055815:Young Adult
D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18
Belize; Cervical cancer; Cost-effectiveness; HPV vaccines