Cost-utility analysis of free HPV immunization for girls in Rajasthan, India

Abstract

Objective: This paper aims to analyze the cost-utility of implementing a government policy to vaccinate adolescent girls (aged 11 years) against Human Papillomavirus (HPV) for free in the state of Rajasthan in India, compared to the current scenario where the HPV vaccination is not part of the state immunization scheme. Methods: A static, decision-analytic Markov model was used to determine the costs and QALYs associated with the intervention and comparator therapies (arms), necessary to calculate the Incremental Cost-Effectiveness Ratio (ICER) from the payer perspective, in this case, the Rajasthan state-funded healthcare perspective. The model parameters were taken from existing studies and expert opinions. Uncertainties in the model were addressed by conducting a sensitivity analysis. Results: Given the costs and the QALYs gained for the model, the intervention of introducing free HPV immunization in Rajasthan is a cost-effective measure with an ICER of -$9548.24/QALY (8,37,822 INR/QALY). Considering all the uncertainties associated with the model, the intervention is not just cost-effective, but cost-saving as well, at a willingness-to-pay threshold of one or three times the Net State Domestic Product (NSDP) per capita of the state of Rajasthan. Conclusion: Overall, the program’s high cost-effectiveness indicates that HPV immunization should be explored at a national level, addressing the evidence gaps identified in this study. Because it is extremely cost-effective to introduce an HPV immunization program for girls in the state of Rajasthan, it serves as a scalable model in similar geo-demographic regions.