Study estimates that nationwide introduction of single-dose HPV vaccination at age 10 in India is highly likely to be cost-effective

A study published in BMJ Global Health estimates the health and economic effects of introducing single-dose or two-dose human papillomavirus (HPV) vaccination in India. The WHO-Strategic Advisory Group of Experts recently updated their recommendation for HPV vaccination to include a single-dose option in addition to the two-dose option, which could make HPV vaccination programs easier to implement and more affordable.

Researchers combined projections from a type-specific HPV transmission model and a cancer progression model to assess the health and economic effects of HPV vaccination at the national and state levels in India, comparing single-dose and two-dose HPV vaccination for a range of scenarios regarding single-dose vaccine protection, coverage, and catch-up. A health care sector payer perspective was used with a time horizon of 100 years.

The findings showed the following:

• Under the base-case scenario of lifelong protection of single-dose vaccination in 10-year-old girls with 90% coverage, the discounted incremental cost-effectiveness ratio (ICER) of nationwide vaccination relative to no vaccination was US$406 (₹INR30 000) per DALY (disability-adjusted life-years) averted. This lay below an opportunity-cost-based threshold of 30% Indian gross domestic product per capita in each Indian state (state-specific ICER range: US$67–US$593 per DALY averted).

• The ICER of two-dose vaccination versus no vaccination was US$1404 (₹INR104 000).

• The ICER of two-dose vaccination versus single-dose vaccination, assuming lower initial efficacy and waning of single-dose vaccination, was at least US$2282 (₹INR169 000) per DALY averted.

The study concluded that nationwide introduction of single-dose HPV vaccination at age 10 in India is highly likely to be cost-effective whereas extending the number of doses from one to two would have a less favorable profile.