The projected cost-effectiveness and budget impact of alternative HPV vaccines in Senegal: A modeling study

This peer-reviewed modeling study, evaluates the projected cost-effectiveness and budget impact of alternative human papillomavirus (HPV) vaccination strategies in Senegal. Using the UNIVAC static cohort model, the authors assessed 23 vaccination strategies varying by vaccine product (Gardasil-4, Gardasil-9, Cervarix, Cecolin), dose schedule (one vs two doses), and coverage levels (current trends, moderate increase, WHO 90% target). Outcomes were estimated for 16 annual cohorts of 9-year-old girls vaccinated between 2019 and 2034, from a government perspective, and included cervical cancer cases, deaths, DALYs averted, and program costs (2022 USD, 3% discount rate).

Key findings

• Under the current strategy (two-dose Gardasil-4 at existing coverage), 130,204 cervical cancer cases and 101,534 deaths are projected over the lifetimes of 16 cohorts.
• Fifteen of the 23 alternative strategies were cost-saving compared to the baseline, improving health outcomes while reducing total costs.
• Cecolin-based strategies (both one- and two-dose schedules) consistently emerged as the most cost-saving options, particularly at higher coverage levels.
• One-dose Cecolin at 90% coverage reduced DALYs by 11.8% and generated net savings of over USD 16 million compared to the baseline.
• Gardasil-9 strategies yielded the greatest health gains (up to 112,866 DALYs averted and 37.5% reduction in DALYs), but at substantially higher program costs.
• At a willingness-to-pay threshold of 30% of GDP per capita (USD 450 per DALY averted), five strategies were considered cost-effective: all Cecolin-based options and one-dose Gardasil-9 at 90% coverage.
• The two-dose Gardasil-9 strategy becomes cost-effective only if the vaccine price falls below USD 20 per dose.
• Higher vaccination coverage substantially improves both health impact and economic efficiency across all vaccine products.

Thumbnail image credit: Gavi