Cost-effectiveness of Human Papillomavirus vaccination in Tanzania

Cooperation project with LSHTM – London School of Hygiene and Tropcial Meicine

Human papillomavirus (HPV) infection is the cause of cervical cancer, a major public health problem in sub-Saharan Africa (SSA). The project is part of the “Dose Reduction Immunobridging and Safety Study of two HPV vaccines in Tanzanian girls [1]” (DoRIS) – a large clinical trial carried out by the London School of Hygiene and Tropical Medicine (LSHTM) [2] in collaboration with the Mwanza Intervention Trials Unit [3] of the Tanzania National Institute for Medical Research.

The goal of DoRIS is to establish whether a single dose of an HPV vaccine produces immune responses that are likely to be effective in preventing cervical cancer in SSA and whether a 2 dose HPV vaccine strategy for girls aged <15 years has similar vaccine responses in SSA as the previously recommended 3 dose regimen. At the same time, the trial will determine whether the new 9-valent vaccine produces similar vaccine responses as the 2-valent vaccine.

DoRIS results will have major implications for cost-effectiveness of HPV vaccination in SSA. A single dose regimen would considerably reduce costs of vaccination, when compared with 2 dose or three dose regimens. However, the overall effects on cost-effectiveness will depend on efficacy of vaccination as found during the trial. Similarly, the 9-valent vaccine has the potential to prevent a considerably larger proportion of HPV associated cancers but again its impact on cost-effectiveness will depend on efficacy and costs of the vaccine.

This project will estimate the cost-effectiveness of 1 dose regimens compared with 2 and 3 dose regimens, and of the 9-valent vaccine compared with the 2-valent vaccine. The project will use efficacy data collected alongside this trial and updated cost data available from a previous study [4], supplemented with information on current vaccination, screening and treatment practices in Tanzania. 

Previous study:

Quentin W, Terris-Prestholt F, Changalucha J, Soteli S, Edmunds J, Hutubessy R, Ross D, Kapiga S, Hayes Rand, Watson-Jones D (2012): Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania. BMC Medicine; 10:137, doi:10.1186/1741-7015-10-137 [5].