Background: Globally, more than half a million women develop cervical cancer each year which comprises approximately 13% of all female cancers. Cervical cancer is the third most common cancer among women worldwide, responsible for 275,000 deaths in 2008. Particularly, women in developing countries account for about 85% of both the annual cases of cervical cancer and the annual deaths from cervical cancer (Ferlay J, 2010a). This proportion is predicted to increase to 90% by 2020 (Agosti and Goldie, 2007).
Knowledge of the burden of disease and the effectiveness of human papillomavirus (HPV) vaccines is not enough to decide whether to introduce vaccines. The costs and benefits of vaccines need to be estimated and compared with those of other potential interventions. By conducting cost-effectiveness analysis (CEA), it is able to make evidence-based decision making and provide efficiency-based arguments. Results from CEA are presented in terms of a cost-per-unit-outcome, or cost-effectiveness ratio.
Thesis objectives: The objective of this thesis is to assess the cost-effectiveness of HPV vaccination compared with no vaccination in Mongolia.
Methods: A cohort Markov model is developed to estimate the cost-effectiveness of the vaccination. The model will follow a single birth cohort of 12 year-old girls over their lifetimes. A CEA is conducted using epidemiological and economic data from the literature, and mortality data of Mongolia.
Results: The cost of implementing HPV vaccination in Mongolia has been estimated at US$6,001,671. When compared to no vaccination, results indicated that an ICER of HPV vaccination is US$1966 per DALY averted at 3% discount rate. HPV vaccination is considered highly cost-effective investment to improve population health because its ICER is lower than the 2010 GDP per capita cost-effectiveness threshold value which is US$2267 per DALY in Mongolia.
Conclusion: From a health sector perspective, HPV vaccination costs US$1966 per DALY averted, and can be considered highly cost-effective. Overall, based on the current evidence, HPV vaccination of 12 year-old girls in Mongolia is recommended.