Introduction of universal human papillomavirus vaccination of girls aged 11 years to the National Immunization Program in Brazil: a cost-effectiveness analysis

Abstract Background Economic evaluations in Brazil are part of the decision processes for incorporation of new health technology, and all vaccines introduced since 2005 in the National Immunization Program had cost-effectiveness studies done. We assessed the cost-effectiveness of introducing universal human papillomavirus (HPV) vaccination into the National Immunization Program. Methods We did this modelling study with the CERVIVAC decision support model, to compare two strategies: (1) status quo with the present Papanicolaou screening programme, and (2) the present screening programme plus vaccination of a cohort of girls aged 11 years. We estimated parameters for national epidemiology, resource use, and cost, on the basis of public health information, national surveys, and published studies. We applied a 5% discount to both future costs and future health benefits. We assessed cost-effectiveness from three perspectives: government (public healh system), health system (public and private health system), and society (health systems and population). We did the analyses with Microsoft Excel. Findings Vaccination of each successive cohort would result in 229 deaths avoided and 6677 disability-adjusted life-years averted. The incremental cost-effectiveness ratio per DALY averted for the Brazilian Government (US$7663), health system (US$7413), and society (US$7298) would be deemed cost-effective, according to WHO parameters. Incremental cost-effectiveness ratios were most sensitive to variations in disease burden, vaccine efficacy, and coverage of serotypes 16 and 18. Vaccine prices have reduced greatly since 2012, and cost, an important driver in previous cost-effectiveness studies, was no longer as important. Interpretation HPV vaccination would be cost-effective with additional benefits for the control of cervical cancer if long term vaccine efficacy is confirmed, but initial large investments are needed from the National Immunization Program. Attaining favourable results will require a sustainable and equitable immunisation programme, an improved screening programme, and a surveillance system. Funding Conselho Nacional de Pesquisa.