title: Projected economic evaluation of the national implementation of a hypothetical HIV vaccination program among adolescents in South Africa, 2012.
abstract: BACKGROUND
  Adolescents in South Africa are at high risk of acquiring HIV. The HIV vaccination of adolescents could reduce HIV incidence and mortality. The potential impact and cost-effectiveness of a national school-based HIV vaccination program among adolescents was determined.
  
  
  METHODS
  The national HIV disease and cost burden was compared with (intervention) and without HIV vaccination (comparator) given to school-going adolescents using a semi-Markov model. Life table analysis was conducted to determine the impact of the intervention on life expectancy. Model inputs included measures of disease and cost burden and hypothetical assumptions of vaccine characteristics. The base-case HIV vaccine modelled cost at US$ 12 per dose; vaccine efficacy of 50 %; duration of protection of 10 years achieved at a coverage rate of 60 % and required annual boosters. Incremental cost-effectiveness ratios (ICER) were calculated using life years gained (LYG) serving as the outcome measure. Sensitivity analyses were conducted on the vaccine characteristics to assess parameter uncertainty.
  
  
  RESULTS
  The HIV vaccination model yielded an ICER of US$ 5 per LYG (95 % CI ZAR 2.77-11.61) compared with the comparator, which is considerably less than the national willingness-to-pay threshold of cost-effectiveness. This translated to an 11 % increase in per capita costs from US$ 80 to US$ 89. National implementation of this intervention could potentially result in an estimated cumulative gain of 23.6 million years of life (95 % CI 8.48-34.3 million years) among adolescents age 10-19 years that were vaccinated. The 10 year absolute risk reduction projected by vaccine implementation was 0.42 % for HIV incidence and 0.41 % for HIV mortality, with an increase in life expectancy noted across all age groups. The ICER was sensitive to the vaccine efficacy, coverage and vaccine pricing in the sensitivity analysis.
  
  
  CONCLUSIONS
  A national HIV vaccination program would be cost-effective and would avert new HIV infections and decrease the mortality and morbidity associated with HIV disease. Decision makers would have to discern how these findings, derived from local data and reflective of the South African epidemic, can be integrated into the national long term health planning should a HIV vaccine become available.
authors.affiliation: Perinatal HIV Research Unit, Faculty of Health Sciences University of the Witwatersrand, PO Box 114, Diepkloof 1864, Johannesburg, South Africa. nishila.moodley@gmail.com.|South African HVTN AIDS Vaccine Early Stage Investigator Program (SHAPe), Seattle, WA, United States. nishila.moodley@gmail.com.|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. nishila.moodley@gmail.com.
authors.forename: Nishila
authors.initials: N
authors.lastname: Moodley
authors.affiliation: South African Medical Research Council, Tygerberg, South Africa.|Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA.
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.affiliation: Health Systems Governance and Finance, World Health Organization, Geneva, Switzerland.
authors.forename: Melanie
authors.initials: M
authors.lastname: Bertram
mesh_terms: D016915:AIDS Vaccines / Q000008:administration & dosage / Q000191:economics*; D000293:Adolescent; D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs / Q000191:economics*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015397:Program Evaluation; D012572:School Health Services / Q000191:economics*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016915:AIDS Vaccines
keywords: Antiretroviral therapy (ART); Cost-effective; HIV; ICER; LYG; Vaccine