Wadie Messoudi1, Toufik Elmahi1, Chakib Nejjari2, Nabil Tachfouti2, Ahmed Zidouh3, Ghali Saadani1, David Moriña4, Mireia Diaz5,6. 1. Laboratory of Coordination of Studies and Research in Analysis and Economic Forecast, Faculty of Law, Economics and Social Sciences, Université Sidi Mohamed Ben Abdellah , Fez , Morocco. 2. Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Université Sidi Mohamed Ben Abdellah , Fez , Morocco. 3. Lalla Salma Foundation for Cancer Prevention and Treatment , Rabat , Morocco. 4. Barcelona Graduate School of Mathematics (BGSMath), Departament de Matemàtiques, Universitat Autònoma de Barcelona (UAB) , Cerdanyola del Vallès (Barcelona) , Spain. 5. Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO) - IDIBELL, L'Hospitalet de Llobregat , Barcelona , Spain. 6. Centro de Investigación Biomédica en Red (CIBERONC) , Madrid , Spain.
Abstract
Objective: Cervical cancer is a huge public health issue in Morocco which represents the second most frequent and fatal cancer among women. Countries that have not yet introduced the HPV vaccine could benefit greatly, but before implementation it is necessary to perform country-specific economic assessments that include current screening practices. Methods: A Markov model was developed to simulate the natural history of HPV and cervical cancer so as to calculate the long-term health benefits and costs of HPV vaccination and current screening by visual inspection with acetic acid (VIA). Starting from a previous transition probability matrix used for a model from Spain, the present model was calibrated to cervical cancer incidence from Morocco. Cost survey data was used to estimate the cost of screening and clinical procedures from the public healthcare perspective. Incremental cost-effectiveness ratios were calculated as 2018US$ per additional year of life saved (YLS) and both costs and health outcomes were discounted at 3%. Results: The expected reduction in lifetime risk of cervical cancer for current screening would be 14% at a cost of US$551/YLS compared with no intervention, assuming VIA every 3 years in women aged 30-49 at 10% coverage. HPV vaccination of pre-adolescent girls at 70% coverage would reduce the lifetime risk of cervical cancer by 62% at a cost of US$1,150/YLS, compared with no intervention. When implementing HPV vaccination in combination with current screening, vaccination would be dominated, and the combined strategy would provide a 69% reduction at a cost of US$2,843/YLS, compared with screening alone. Current screening would be dominated by vaccination when screening coverage is higher than 15%, whereas the combined strategy rapidly exceeds US$4,000/YLS. Conclusions: HPV vaccination could be highly effective and cost-effective in Morocco. Current screening would be good value for money compared with no intervention, but scaling-up screening coverage would make it inefficient compared with vaccination.
Objective: Cervical cancer is a huge public health issue in Morocco which represents the second most frequent and fatal cancer among women. Countries that have not yet introduced the HPV vaccine could benefit greatly, but before implementation it is necessary to perform country-specific economic assessments that include current screening practices. Methods: A Markov model was developed to simulate the natural history of HPV and cervical cancer so as to calculate the long-term health benefits and costs of HPV vaccination and current screening by visual inspection with acetic acid (VIA). Starting from a previous transition probability matrix used for a model from Spain, the present model was calibrated to cervical cancer incidence from Morocco. Cost survey data was used to estimate the cost of screening and clinical procedures from the public healthcare perspective. Incremental cost-effectiveness ratios were calculated as 2018US$ per additional year of life saved (YLS) and both costs and health outcomes were discounted at 3%. Results: The expected reduction in lifetime risk of cervical cancer for current screening would be 14% at a cost of US$551/YLS compared with no intervention, assuming VIA every 3 years in women aged 30-49 at 10% coverage. HPV vaccination of pre-adolescent girls at 70% coverage would reduce the lifetime risk of cervical cancer by 62% at a cost of US$1,150/YLS, compared with no intervention. When implementing HPV vaccination in combination with current screening, vaccination would be dominated, and the combined strategy would provide a 69% reduction at a cost of US$2,843/YLS, compared with screening alone. Current screening would be dominated by vaccination when screening coverage is higher than 15%, whereas the combined strategy rapidly exceeds US$4,000/YLS. Conclusions: HPV vaccination could be highly effective and cost-effective in Morocco. Current screening would be good value for money compared with no intervention, but scaling-up screening coverage would make it inefficient compared with vaccination.
Authors: Mouaddh Abdulmalik Nagi; Mustafa Ali Ali Rezq; Sermsiri Sangroongruangsri; Montarat Thavorncharoensap; Pramitha Esha Nirmala Dewi Journal: Glob Health Res Policy Date: 2022-07-25
Authors: Nicole G Campos; Maria Demarco; Laia Bruni; Kanan T Desai; Julia C Gage; Sally N Adebamowo; Silvia de Sanjose; Jane J Kim; Mark Schiffman Journal: Prev Med Date: 2021-03-04 Impact factor: 4.018