title: The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis.
abstract: Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.
authors.affiliation: From the Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (NM, GG); South African HVTN AIDS Vaccine Early Stage Investigator Program (SHAPe) (NM); The South African Department of Science and Technology/National Research Foundation (DST/NRF), Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa (NM); and Health Systems Governance and Finance, World Health Organization, Geneva (MB).
authors.forename: Nishila
authors.initials: N
authors.lastname: Moodley
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.forename: Melanie
authors.initials: M
authors.lastname: Bertram
mesh_terms: D016915:AIDS Vaccines / Q000191:economics*; D000293:Adolescent; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D012572:School Health Services / Q000191:economics; D013019:South Africa; D014611:Vaccination / Q000191:economics*
chemical_list: D016915:AIDS Vaccines
references.citation: Pediatrics. 2012 Jun;129(6):1056-63
references.pmid: 22566425
references.citation: Vaccine. 2011 Aug 18;29(36):6107-12
references.pmid: 21736912
references.citation: BMC Public Health. 2011 Jul 05;11:534
references.pmid: 21729309
references.citation: Int Perspect Sex Reprod Health. 2009 Jun;35(2):82-90
references.pmid: 19620092
references.citation: N Engl J Med. 2009 Dec 3;361(23):2209-20
references.pmid: 19843557
references.citation: AIDS. 2005 Jan 28;19(2):193-201
references.pmid: 15668545
references.citation: Sex Health. 2012 Mar;9(1):51-8
references.pmid: 22348633
references.citation: Cost Eff Resour Alloc. 2013 Mar 25;11(1):6
references.pmid: 23531194
references.citation: Lancet. 2008 Nov 29;372(9653):1894-1905
references.pmid: 19012957
references.citation: BMC Health Serv Res. 2014 Sep 30;14:444
references.pmid: 25265883
references.citation: PLoS Med. 2010 Mar 16;7(3):e1000249
references.pmid: 20305714
references.citation: PLoS One. 2014 Sep 10;9(9):e107214
references.pmid: 25207973
references.citation: Health Aff (Millwood). 2007 Jul-Aug;26(4):962-70
references.pmid: 17630438
references.citation: S Afr Med J. 2015 Sep 23;105(8):638-40
references.pmid: 26449706
references.citation: Oncologist. 2014 May;19(5):466-76
references.pmid: 24710309
references.citation: J Acquir Immune Defic Syndr. 2006 Oct 1;43(2):219-25
references.pmid: 16951648
references.citation: PLoS Med. 2006 Jan;3(1):e4
references.pmid: 16318413
references.citation: Med Decis Making. 2002 Nov-Dec;22(6):475-81
references.pmid: 12458977
references.citation: Curr Opin HIV AIDS. 2013 Jul;8(4):306-10
references.pmid: 23743721
references.citation: Lancet. 2008 Nov 29;372(9653):1881-1893
references.pmid: 19012954
references.citation: Oncologist. 2012;17(2):164-71
references.pmid: 22302231
references.citation: Lancet. 2009 Sep 12;374(9693):934-47
references.pmid: 19709736
references.citation: Vaccine. 2011 Aug 18;29(36):6113-24
references.pmid: 21510996
references.citation: Pharmacoeconomics. 2001;19(9):937-46
references.pmid: 11700780
references.citation: Sex Transm Dis. 2005 Oct;32(10):635-40
references.pmid: 16205306
references.citation: Vaccine. 2012 Dec 17;31(1):96-108
references.pmid: 23142307
references.citation: Int J Infect Dis. 2007 Nov;11 Suppl 2:S26-8
references.pmid: 18162242