Session: Demand and Supply Considerations for Human Papillomavirus Vaccine (HPV) Introduction in Low and Middle-Income Countries

Session Title: Demand and Supply Considerations for Human Papillomavirus Vaccine (HPV) Introduction in Low and Middle-Income Countries

Time: Monday 10:15 a.m.-11:30 a.m.
Room Bayside 104
Session Type: Abstract Driven Session

Chair: Marc Brisson (University of Laval, Centre de recherche FRSQ du CHA universitaire de Québec, Hôpital du Saint-Sacrement)

Organizer (1): Raymond Hutubessy (World Health Organization)

Session Description (476 words)

Human papillomavirus vaccines have several public goods properties that trigger public interventions directed to stimulate both supply and demand. At the macro level there are interventions to support vaccine development, pricing and vaccine procurement in low and middle-income countries (LMICs). At the micro level, there is public sector financing for HPV vaccine service delivery. Despite these interventions, some middle income-countries continue to perceive the vaccine as unaffordable. Is HPV vaccination affordable and how can the likelihood of its introduction be improved?

Purpose:
The purpose of the session is two-fold:
a) To address global and national economic factors influencing HPV introduction decisions, specifically focusing on similarities and differences between developed and developing countries;
b) To introduce and familiarize analysts in low and middle income countries with issues around affordability and value for money of HPV vaccination, together with available economic decision tools to support such decisions.

Content:
Currently decision makers face challenges regarding value for money and affordability issues on HPV vaccine introduction globally. Numerous economic analyses have been conducted to inform vaccine introduction decisions in high income countries. However these economic challenges are different in high income countries compared to low income countries. In the first group of countries the public market price, which can be as high as 130 US$ per dose, offered by vaccine manufacturers is a major obstacle for national decision makers to publicly finance the vaccine. In the low income countries where HPV vaccines prices are negotiated downwards towards relatively low prices (6US$-80US$ per dose) with support from organizations such as the GAVI Alliance or the PAHO revolving fund, the delivery costs of the vaccination program itself have becomes a major introduction barrier rather than the price of the vaccines itself. As the existing infrastructure in many low and middle income countries is not adequate to reach adolescent girls, in particular those not attending schools, substantial investments are required to start up the program in these countries. However, many low and middle income countries report lacking the technical capacity to conduct analyses about the investments they require and their value for money.

The session will start with a discussion on economic considerations that affect comprehensive cervical cancer prevention and control in low- and middle-income countries. The second session will discuss factors influencing the market dynamics of HPV vaccines that affect their affordability including an overview of the tier pricing developments of HPV vaccines globally. Next issues around costing and planning HPV vaccination delivery programs will be discussed, along with a presentation of the WHO’s comprehensive Cervical Cancer Prevention and Control Costing (C4P) tool. The last session will shed on light on the value for money of HPV vaccines in low and middle income countries along with a discussion of using the WHO supported Papillomavirus Rapid Interface for Modelling and Economics (PRIME). Case studies and country experiences will be presented in each session.

Theme: Health technology assessment
Key Terms: Economic evaluations, HPV vaccines, cervical cancer, low and middle income countries

Presentations (3)

Introduction to economic considerations and decision tools for comprehensive cervical cancer prevention and control in LMICs

Presenter: Ann Levin (Levin and Morgan)
Theme: Application
Abstract (150 words)

This paper reviews the economic considerations that affect comprehensive cervical cancer prevention and control in low- and middle-income countries. It also discusses decision tools that could be used. The authors conducted a review of key factors affecting the introduction in HPV vaccination in low and middle-income countries: burden of disease, HPV vaccine pricing, service delivery costs, and comparison of HPV vaccine with other new and under-utilized vaccines, and source of financing. Several decision tools are available for assisting with the introduction of HPV vaccine. These range from cost analysis, budget impact, epidemiological modeling, cost-effectiveness, and threshold price analysis. The decision to use any of these will depend on which question is being asked by the government. Some tools that have been developed to assist governments with decision-making on the introduction of HPV vaccine – the WHO cervical cancer prevention and control costing tool (C4P costing tool) and PRIME Cost-Effectiveness tool.

Key Terms: HPV vaccines, cervical cancer, cost analysis, cost-effectiveness analysis
Authors (2): Ann Levin (Independent Consultant. Health Economist) and Raymond Hutubessy (World Health Organization. Initiative for Vaccine Research)

Funding Sources: NONE
Is the HPV Vaccine Market favorable for introduction in LMICs?

Presenter: Claudio Politi (World Health Organization. Expanded Programme for Immunization)
Theme: Application
Abstract (293 words)

Many low and middle income countries are considering the introduction of HPV vaccine as national immunization and reproductive health programs develop strategic plans to prevent and control cervical cancer. However, the affordability of the HPV vaccine is often a major obstacle to its introduction despite some significant reductions in its price. The objective of this paper is to discuss factors influencing the market dynamics of HPV vaccines that affect their affordability. This information will assist policymakers in their decision-making on HPV vaccine introduction. Data were collected on product development, their supply, demand for the vaccines, sources of financing and implementation strategies as well as vaccine revenues and prices in the public and private sector for different countries. Both peer-reviewed and gray literature were reviewed, including summaries of regional meetings on cervical cancer control programs. The study results indicate that the supply and demand for HPV vaccines is highly dynamic as new sources of finance are becoming available for low-income and some lower-middle income countries. In the short-term, the price of the vaccines in high-income countries is likely to remain stable, despite price reductions in some countries, due to the duopoly supply situation and the high cost of production of first-generation vaccines. However, the price of vaccines is decreasing in low and middle-income countries as predictable demand and assured funding are growing and production capacity is not fully used. Demand for the HPV vaccine is gradually becoming more widespread as it becomes more widely available in low- and middle-income countries. Important issues of access to the HPV vaccine remain though for low and middle-income countries. In the longer-term, HPV vaccines created with new technologies and better dialogue between donors, developers, producers and countries are likely to be of lower cost, more suitable and affordable.

Key Terms: HPV vaccines, cervical cancer, vaccine market, vaccine prices
Authors (3): Claudio Politi (World Health Organization. Expanded Programme for Immunization) , Ann Levin (Independent Consultant. Health Economist) and Miloud Kaddar (World Health Organization. Expanded Programme for Immunization)

Funding Sources: Funds from the GAVI Alliance Business Plan 2012.

Publication History: In Review
Under review with BMC Medicine
Is it cost-effective to vaccinate girls against HPV in LMICs?

Presenter: Mark Jit (Health Protection Agency. Modelling and Economics Unit)
Theme: Application
Abstract (202 words)

Introduction: While the cost-effectiveness of vaccinating girls against HPV prior to sexual debut has been extensively investigated in high income countries, there have been fewer studies in LMICs. Assessing the cost-effectiveness of HPV vaccination often requires the use of complex models with data and expertise requirements that are prohibitive in such settings. However, some situations can be investigated using much simpler models. Methods: PRIME (Papillomavirus Rapid Interface for Modelling and Economics) is a simple Excel-based model that estimates an upper bound for the cost-effectiveness of vaccinating girls prior to sexual debut against HPV in a setting with no routine screening. PRIME was validated against published HPV cost-effectiveness studies in the literature and used with publicly available data sources to evaluate HPV cost-effectiveness in all 141 LMICs. Results: Female HPV vaccination is likely to be cost-effective in most countries at prices similar to those at which the GAVI Alliance purchases the vaccines under its Advanced Market Commitments. As prices increase above this however cost-effectiveness is less certain. Discussion: Models like PRIME offer a way of rapidly assessing the cost-effectiveness of HPV vaccination in simple situations, and are complementary to more complex models that can evaluate other situations such as catch-up and male vaccination.

Key Terms: HPV vaccines, cervical cancer, cost analysis, cost-effectiveness analysis
Authors (4): Mark Jit (Health Protection Agency. Modelling and Economics Unit) , Allison Portnoy (World Health Organization. Initiative for Vaccine Research) , Marc Brisson (University of Laval. Research Unit, Population Health) and Raymond Hutubessy (World Health Organization. Initiative for Vaccine Research)

Funding Sources: This work was funded by the World Health Organization.