title: The economic evaluation of human papillomavirus vaccination strategies against cervical cancer in women in Lao PDR: a mathematical modelling approach.
abstract: Cervical cancer, a preventable disease, is the third leading cause of cancer morbidity and mortality in the Lao People's Democratic Republic (Lao PDR). Since many cervical cancers are linked to human papilloma virus (HPV) infection, vaccination against this virus may lead to a reduction in these types of cancer. The study described here is the first to compare the cost-effectiveness of different HPV vaccination options in Lao PDR.
  
  
  
  A dynamic compartment model was created. The model included routine screening activities already in place, as well as theoretical interventions that included a 10-year old girl-only vaccination programme combined with/without a 10-year old boy vaccination programme and/or a catch-up component. The simulation was run over 100 years. In base case analyses, we assumed 70 % vaccination coverage with lifelong protection and 100 % efficacy against HPV types 16/18. The outcomes of interest were the incremental cost per Disability-Adjusted Life Year (DALY) averted.
  
  
  
  In base case analyses, according to the WHO definition of cost-effectiveness thresholds, vaccinating 10-year-old girls was very cost-effective. Adding a catch-up vaccination element for females aged 11-25 years was also very cost-effective, costing 1559 international dollars (I$) per DALY averted. Increasing the age limit of the catch-up vaccination component to 75 years old showed that this remained a cost-effective option (I$ 5840 per DALY averted). Adding a vaccination programme for 10-year-old boys was not found to be cost-effective unless a short time simulation (30 years or less) was considered, along with a catch-up vaccination component for both males and females.
  
  
  
  Adding a catch-up female vaccination component is more attractive than adding a 10-year-old boy vaccination component.
authors.affiliation: Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR. Phetsavanh@tropmedres.ac.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand. Phetsavanh@tropmedres.ac.
authors.forename: Phetsavanh
authors.initials: P
authors.lastname: Chanthavilay
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, 1050, avenue de la Médecine, Quebec, QC G1V 0A6, Quebec, Canada.|Institut de la Francophonie pour la Médecine tropicale, Vientiane, Lao PDR.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
authors.affiliation: Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR.|Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Samsenthai Road, P.O. Box 744, Vientiane, Lao PDR.|Centre for Tropical Medicine and Global Health, Churchill Hospital, University of Oxford, Oxford, UK.
authors.forename: Mayfong
authors.initials: M
authors.lastname: Mayxay
authors.affiliation: Gynecologic Oncology Unit, Setthathirath Hospital, Ban Donekoi, Sisatthanak Districk, P.O.Box: 6088, Vientiane, Lao PDR.
authors.forename: Keokedthong
authors.initials: K
authors.lastname: Phongsavan
authors.affiliation: Gynecologic Oncology Unit, Setthathirath Hospital, Ban Donekoi, Sisatthanak Districk, P.O.Box: 6088, Vientiane, Lao PDR.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Marsden
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, 1050, avenue de la Médecine, Quebec, QC G1V 0A6, Quebec, Canada.
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.|Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007812:Laos; D008875:Middle Aged; D008962:Models, Theoretical; D030361:Papillomavirus Infections / Q000191:economics / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D019057:Quality-Adjusted Life Years; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014611:Vaccination / Q000191:economics*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer; Economic evaluation; HPV vaccination; Lao PDR