Human papillomavirus vaccination at the national level in Tunisia: a cost-effectiveness analysis using a comparative modeling study.

Cervical cancer is one of the most prevalent cancer diseases in women caused by persistent infection with one of 13 sexually transmitted high-risk human papillomavirus (HPV) types. Vaccination can significantly reduce the prevalence of this burden in low-middle income countries. However, HPV vaccination is not included in the Tunisian immunization program. Since the economic evaluation of HPV vaccines is crucial to inform public-health decisions, the World Health Organization (WHO) recommends that a cost-effectiveness analysis of HPV vaccination is conducted before nationwide introduction. This study aimed to conduct a cost-effectiveness analysis of incorporating different HPV vaccines into the national immunisation schedule in Tunisia. The potential health and economic impacts of human papillomavirus (HPV) vaccination were evaluated through comparative modelling analysis using two published static models (UNIVAC and Papillomavirus Rapid Interface for Modelling and Economics (PRIME)). Academic literature and anecdotal evidence were included on the demographic variables, cervical cancer incidence and mortality, treatment costs, vaccine delivery costs and other model parameters. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted and reported as primary outcomes. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET) defined by the World Health Organisation (WHO). All HPV vaccines were very cost effective (with every disability-adjusted life-year averted costing less than the cost-effectiveness threshold). The analyses were done from a health system and societal perspective. Despite model differences, the PRIME and UNIVAC models yielded similar vaccine-impact estimates.