TÜRKİYE’DE HPV AŞISININ ULUSAL BAĞIŞIKLAMA PROGRAMINA DAHİL EDİLMESİNİN MALİYET ETKİLİLİK ANALİZİ

Abstract

This study aimed to determine the cost-effectiveness of including human papillomavirus (HPV) vaccines to Türkiye’s national vaccination schedule. The analysis was a model-based cost-effectiveness study conducted using PRIME (Papillomavirus Rapid Interface for Modelling and Economics), a WHO-developed tool later updated to enable the evaluation of single-dose immunization scenarios and was grounded in nationally available public data and the published literature. Demographic inputs were obtained from Turkish Statistical Institute (TURKSTAT), population projections from the United Nations World Population Prospects (UN WPP), disease burden parameters from World Health Organization/Institute for Health Metrics and Evaluation (WHO/IHME), cervical cancer incidence and mortality inputs from Global Cancer Observatory (GLOBOCAN), and vaccine costs from Pan American Health Organization (PAHO) price lists. In the base-case analysis, the target age was set at 12 years, vaccine coverage at 55%, and the discount rate at 3%. The evaluated strategies were defined as S1 (quadrivalent vaccine, 1 dose), S2 (quadrivalent vaccine, 2 doses), S3 (nonavalent vaccine, 1 dose), and S4 (nonavalent vaccine, 2 doses). Uncertainty was assessed using one-way sensitivity analyses, best-worst case scenarios, and probabilistic sensitivity analyses. Using a 3% discount rate, the results were as follows: for S1, net cost was 5,558,397 $, total DALYs averted were 3,436, and the ICER was 1,617.93 $ per DALY averted; for S2, net cost was 11,719,027 $, DALYs averted were 3,840, and the ICER was 3,052.08 $ per DALY averted. Under the same assumptions, for S3 net cost was 6,877,207 $, total DALYs averted were 4,677, and the ICER was 1,470.46 $ per DALY averted; for S4 net cost was 14,631,953 $, DALYs averted were 4,937, and the ICER was 2,963.89 $ per DALY averted. One-way sensitivity analyses indicated that results were particularly sensitive to the discount rates, vaccine effectiveness, the attributable fraction (preventable proportion), and assumptions regarding the target age. In the threshold analysis for single-dose strategies, the condition ICER<1×GDP per capita remained satisfied for both single-dose scenarios even when the vaccine unit price was increased to 2n-5n levels. HPV vaccination of 12-year-old girls in Turkey generates health gains across all assessed strategies and is economically feasible. Limitations include the PRIME model’s static structure (excluding herd immunity), a scope limited to cervical cancer, and the exclusion of indirect costs.