Cervical cancer prevention in Morocco: a model-based cost-effectiveness analysis

Area of Science:

• Public Health
• Oncology
• Health Economics

Background:

• Cervical cancer is a significant public health concern in Morocco, ranking as the second most frequent and fatal cancer among women.
• Economic assessments are crucial for evaluating the implementation of the human papillomavirus (HPV) vaccine, considering existing screening practices.

Purpose of the Study:

• To conduct a country-specific economic assessment of HPV vaccination and current cervical cancer screening practices in Morocco.
• To evaluate the long-term health benefits and costs associated with HPV vaccination and visual inspection with acetic acid (VIA) screening.

Main Methods:

• A Markov model was developed and calibrated to Moroccan cervical cancer incidence data.
• The model simulated the natural history of HPV and cervical cancer to compare costs and health outcomes (Years of Life Saved - YLS) of different interventions.
• Cost data from public healthcare perspectives were utilized, with costs and outcomes discounted at 3%.

Main Results:

• Current screening (VIA every 3 years, 10% coverage) is projected to reduce lifetime cervical cancer risk by 14% at US$551/YLS.
• HPV vaccination (70% coverage) is projected to reduce risk by 62% at US$1,150/YLS.
• Combining HPV vaccination with screening yields a 69% reduction at US$2,843/YLS, but vaccination alone becomes more cost-effective than screening when coverage exceeds 15%.

Conclusions:

• HPV vaccination presents a highly effective and cost-effective strategy for cervical cancer prevention in Morocco.
• Current screening offers value for money compared to no intervention, but its efficiency diminishes relative to vaccination at higher coverage levels.