Article ; Online: Informing Global Cost-Effectiveness Thresholds Using Country Investment Decisions: Human Papillomavirus Vaccine Introductions in 2006-2018.
2020 Volume 24, Issue 1, Page(s) 61–66
Abstract: Objectives: Cost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 ... ...
| Abstract | Objectives: Cost-effectiveness analysis can guide decision making about health interventions, but the appropriate cost-effectiveness threshold to use is unclear in most countries. The World Health Organization (WHO) recommends vaccinating girls 9 to 14 years against human papillomavirus (HPV), but over half the world's countries have not introduced it. This study aimed to investigate whether country-level decisions about HPV vaccine introduction are consistent with a particular cost-effectiveness threshold, and to estimate what that threshold may be. Methods: The cost-effectiveness of vaccinating 12-year-old girls was estimated in 179 countries using the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model, together with vaccine price data from World Health Organization's Market Information for Access to Vaccines database. In each year from 2006 to 2018, countries were categorized based on (1) whether they had introduced HPV vaccination, and (2) whether the incremental cost-effectiveness ratio for HPV vaccine introduction fell below a certain cost-effectiveness threshold. Results: A cost-effectiveness threshold of 60% to 65% of GDP per capita has the best ability to discriminate countries that introduced vaccination, with a diagnostic odds ratio of about 7. For low-income countries the optimal threshold was lower, at 30% to 40% of GDP per capita. Conclusions: A cost-effectiveness threshold has some ability to discriminate between HPV vaccine introducer and non-introducer countries, although the average threshold is below the widely used threshold of 1 GDP per capita. These results help explain the current pattern of HPV vaccine use globally. They also inform the extent to which cost-effectiveness thresholds proposed in the literature reflect countries' actual investment decisions. |
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| MeSH term(s) | Cost-Benefit Analysis/statistics & numerical data ; Developing Countries/economics ; Developing Countries/statistics & numerical data ; Global Health ; Humans ; Immunization Programs/economics ; Immunization Programs/statistics & numerical data ; Models, Economic ; Papillomavirus Infections/economics ; Papillomavirus Infections/epidemiology ; Papillomavirus Infections/prevention & control ; Papillomavirus Vaccines/administration & dosage ; Papillomavirus Vaccines/economics ; Quality-Adjusted Life Years |
| Chemical Substances | Papillomavirus Vaccines |
| Language | English |
| Publishing date | 2020-10-16 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 1471745-1 |
| ISSN | 1524-4733 ; 1098-3015 |
| ISSN (online) | 1524-4733 |
| ISSN | 1098-3015 |
| DOI | 10.1016/j.jval.2020.07.012 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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