Cost-effectiveness analysis of the introduction of the XXXX vaccine in Honduras.

@entity1 @entity5 @entity1799 @entity1082 @entity204
BACKGROUND: @entity5 is the leading cause of @entity5 @entity204 in Honduras. With the availability of a vaccine to prevent @entity1082 ), the causative agent for @entity5 , the Honduran Secretary of Health undertook a cost-effectiveness analysis of introducing the HPV vaccine to support their national decision-making process. METHODS: A national multidisciplinary team conducted this analysis with the CERVIVAC model, developed by the London School of Hygiene and Tropical Medicine in collaboration with the Pan American Health Organization's ProVac Initiative. The cumulative costs and health benefits of introducing the HPV vaccine were assessed over the lifetime of one single cohort of 11-year-old @entity1 . We assumed a three-dose series with 95% vaccination coverage of the cohort using a mixture of school-based and facility-based delivery. To estimate national @entity5 cases and @entity204 , we used United Nations demographic projections and GLOBOCAN estimates based on registry data from El Salvador, Guatemala, and Nicaragua. Based on estimates from the World Health Organization (WHO) and the Division of Intensified Cooperation with Countries (ICO), we assumed that 70% of @entity5 would be due to vaccine types @entity1799 and HPV18. We used a vaccine dose price of US  13.45 and evidence from the scientific literature to estimate vaccine effectiveness. National information was used to estimate health service utilization and costs of @entity5 treatment. All costs and health benefits were discounted at 3%. RESULTS: Upon fully vaccinating 86,906 11-year old @entity1 , 2250 (undiscounted) @entity5 cases and 1336 (undiscounted) @entity204 would be prevented over the lifetime of the cohort. After discounting future health benefits at 3% per year, the equivalent cases and @entity204 prevented were 421 and 170. HPV vaccination is estimated to cost around US  5 million per vaccinated cohort, but this would be offset by around US  1 million in avoided costs borne by the government to treat @entity5 . Furthermore, 4349 discounted disability adjusted life years (DALYs) could be avoided at a cost of US  926 per DALY avoided, making HPV vaccination in Honduras a highly cost-effective intervention. DISCUSSION: The net cost of HPV vaccination per DALY avoided is less than the WHO threshold for cost-effectiveness. However, at a cost of around US  5 million per vaccinated cohort, an important element to consider in this discussion is the budgetary implications that the introduction of the HPV vaccine would cause for the country. CONCLUSIONS: When comparing the costs and benefits of HPV vaccine introduction in Honduras, it is clear that this intervention would be highly cost-effective and that the intervention would greatly reduce @entity5 disease. For these reasons, it is in the country's best interest to explore financing opportunities that could support the vaccine's introduction.
