Cost-effectiveness of HPV vaccine introduction in Morocco

Introduction According to Globocan 2012 nearly 52,800 new cases were estimated and 266,000 deaths due to cervical cancer. The majority of this burden, about 84 %, occurs in less developed regions. In Morocco, cervical cancer ranks second among women after breast cancer, with 2258 incident cases and 1076 deaths in 2012. Organized cervical cancer screening based on VIA every 3 years in women aged 30–49 was launched in 2010 as part of the prevention and control policy of cancer. The coverage rate at the national level is less than 10 % of the targeted women and 70 %–80 % of all cervical cancer cases were diagnosed at an advanced stage. The WHO recommends that developing countries, which have difficulty in implementing screening program, may reap an important benefit from HPV vaccination as a primary prevention strategy for cervical cancer disease. The aim of this project was to assess the long-term health benefits and the economic impact of implementing an HPV vaccination program in Morocco. Methods To assess the cost-effectiveness of preventive strategies of cervical cancer, a Markov model was developed to simulate the natural progression from HPV infection to cervical cancer diseases with a cohort ( n  = 277,920) of Moroccans girls starting from 14 years of age and followed until 75 years of age. After empirical calibrating we projected cervical cancer incidence, life expectancy and lifetime cost (US$ 2015) and we calculated the incremental cost ratio (US$/YLS) for the following strategies : pre-adolescent vaccination of girls before age 14, VIA screening of women, and combined vaccination and screening. Results At 70 % of vaccinated girls, vaccination alone was the most cost-effective strategy with an ICER of USD 207/YLS. Incremental cost-effectiveness of the existing screening program was evaluated and could be cost-effective when it compared to the GDP threshold and it was weakly dominated by vaccination. The combined strategy was the most costly and the more effective strategy, it displayed an incremental cost-effectiveness ratio US$ 21 030/YLS exceeding the cost-effectiveness threshold more than 3 times (2847 US$ GDP per habitat 2015). Conclusion Sensitivity analysis showed at the observed screening rate, the vaccination alone still the most cost-effective even with low vaccination rates. While, when the screening program is supposed to be promoted cost-effectiveness results bypass in favor of higher screening rate, from 20 to 60 % screening coverage, the VIA strategy might be cost-effective, it's was less costly and more effective than screening under the observed rate.