DOI: 10.1002/cncr.31075, Published online Month 00, 2017
Cost-Effectiveness Calculations of Human Papillomavirus Vaccination in Punjab
May Be Flawed
Prinja et al1 looked at the cost-effectiveness of the human papillomavirus (HPV) vaccine for adolescent girls in Punjab, India. They assumed that the cost of vaccination would be US $14.1 per child. The report suggests a 90% probability that vaccination would be cost-effective in Punjab (at a willingness-to-pay threshold of 10,000 Indian rupees per quality-adjusted life-year gained, which is one-tenth of the gross domestic product per capita [65 Indian rupees 5 US $1]). This contrasts with the findings of Diaz et al,2 who examined health and the economic impact of HPV vaccination and found that as the cost per vaccinated girl exceeded US $3.30, vaccination alone would no longer be more efficient than screening alone.
For their calculations, Prinja et al1 estimated that in the current scenario in Punjab, with no one vaccinated against HPV, 1140 cases of cervical cancer due to HPV- 16 and HPV-18 occur during the lifetime of a given year’s birth cohort. They suggested that vaccinating 70% of the population with a vaccine that is 93% effective would bring this down to 400 cases and result in the prevention of 740 cases of cervical cancer. “Ultimately,” they wrote, “it would lead to a reduction of 733 deaths due to cervical cancer.” They estimated that vaccinating girls would result in saving 18,477 life-years.
There are a few problems with these estimates:
1. The calculations suggest that despite expensive private- sector treatment, the mortality rate for cervical cancer is 99.1% in Punjab (733 deaths among 740 cases). This mortality rate for cervical cancer is unprecedented anywhere in the world.
2. Furthermore, they estimated that, on average, 25 life- years would be saved per death avoided (733 lives saved and 18,477 life-years saved). Because the life expec- tancy among women in Punjab is 72 years,3 this could be true if, on average, all the deaths from cervical cancer were to occur at the age of 47 years. However, 56% of cervical cancer cases develop only after the age of 50 years.4
There appears to be an error in these projections. Cost-effectiveness calculated with these assumptions may not be correct. We hope that the authors will clarify this.
No specific funding was disclosed.
CONFLICT OF INTEREST DISCLOSURES
The authors made no disclosure.
2. 3. 4.
Prinja S, Bahuguna P, Faujdar DS, et al. Cost-effectiveness of human papillomavirus vaccination for adolescent girls in Punjab state: impli- cations for India’s universal immunization program. Cancer. 2017; 123:3253-3260.
Diaz M, Kim JJ, Albero G, et al. Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India. Br J Cancer. 2008;99:230-238.
Sinha K. Average Indian’s life expectancy up 4.6 years. http:// timesofindia.indiatimes.com/india/Average-Indians-life-expectancy-up- 4-6-years/articleshow/16633612.cms. Accessed June 7, 2017.
Bruni L, Barrionuevo-Rosas L, Albero G, et al. Human papillomavirus and related diseases report: India. http://hpvcentre.net/statistics/reports/ IND.pdf. Published April 19, 2017. Accessed June 7, 2017.
Vivian Suman, DCH Jacob M. Puliyel, MD, MRCP, MPhil
Department of Pediatrics St Stephens Hospital Delhi, India
DOI: 10.1002/cncr.31075, Published online Month 00, 2017 in Wiley Online Library (wileyonlinelibrary.com)