Cost-effectiveness of Human Papilloma Virus (HPV) vaccination in Nigeria: a decision analysis using pragmatic parameter estimates for cost and programme coverage

Table 4 Result of sensitivity analysis

Name of strategy	Costs (US$)	Effectiveness (DALYs)	Incremental Costs	Incremental Effectiveness (DALY averted)	ICER (US$ / DALY averted)	Annual CC incidence per 100,000	Remark
2 × screening per life time
CS	8.05	0.00429	–	–	–	17.06	–
NS alone	12.06	0.00414	4.01	0.00015	–	16.03	Dom
CS + NV	18.32	0.00302	10.27	0.00127	8087	11.66	R
NS + NV	21.84	0.00293	3.52	0.00009	39,111	11.03	NR
3 × screening per life time
CS	8.07	0.00430	–	–	–	17.03	–
NS alone	13.58	0.00413	5.51	0.00017	–	15.85	Dom
CS + NV	18.26	0.00300	10.19	0.00130	7838	11.61	R
NS + NV	23.31	0.00288	5.05	0.00012	42,083	10.80	NR
National screening programme achieving 40% coverage
CS	8.02	0.00427	–	–	–	16.95	–
NS alone	13.48	0.00402	5.46	0.00025	–	15.52	Dom
CS + NV	18.16	0.00295	10.14	0.00132	7682	11.38	R
NS + NV	23.00	0.00280	4.84	0.00015	32,267	10.49	NR
National screening programme achieving 60% coverage
CS	7.98	0.00427	–	–	–	17.15	–
NS alone	16.61	0.00387	8.63	0.00040	–	14.69	Dom
CS + CV	18.26	0.00301	10.28	0.00126	8159	11.59	R
NS + NV	25.98	0.00276	7.72	0.00025	30,880	10.10	NR
National vaccination programme achieving 90% coverage
CS	8.02	0.00429	–	–	–	16.90	–
NS alone	10.30	0.00420	2.28	0.00009	–	16.39	Dom
CS + NV	21.70	0.00257	13.68	0.00172	7953	9.73	R
NS + NV	23.53	0.00253	1.83	0.00004	45,750	9.46	NR
National vaccination programme achieving 50% coverage
CS	8.00	0.00426	–	–	–	17.02	–
NS alone	10.28	0.00417	2.28	0.00009	–	16.47	Dom
CS + NV	15.65	0.00336	7.65	0.00090	8500	12.87	R
NS + NV	17.67	0.00329	2.02	0.00007	28,857	12.48	NR

Cost-effectiveness threshold = US$ 9609.9/DALY averted
$ ICER=\frac{Strategy\kern0.5em \cos t- Current\kern0.5em scenario\kern0.5em \cos t}{Current\kern0.5em scenario\kern0.5em DALYs\kern0.5em lost- Startegy\kern0.5em DALYs\kern0.5em lost} $
Gavi vaccine price ($4.5/dose) used for all analysis
CS current scenario of opportunistic screening
NS, National cervical cancer screening, NV National HPV vaccination, DALY disability adjusted life years, CC cervical cancer, R recommended, NR not recommended, Dom dominated

ISSN: 1472-6963