Cost-effectiveness of human papillomavirus vaccination in Jordan: A modelling study

Cervical cancer remains a preventable but persistent public health challenge. Human papillomavirus (HPV) vaccination offers an effective strategy to reduce cervical cancer incidence and mortality, but there is limited evidence on its potential impact and cost-effectiveness in Jordan.

We modelled the lifetime costs and consequences of a single-dose HPV vaccination program (2026-2035) for girls aged 12 years in Jordan. The primary outcome measure was the cost (2023 USD) per disability-adjusted life year (DALY) averted, from a government perspective. The comparator was a scenario with no HPV vaccination and no change in existing cervical cancer screening services. We calculated vaccine program costs, and cervical cancer cases, deaths, DALYs and healthcare costs averted by three alternative HPV vaccine products (Cecolin®, Cervarix™ and Gardasil®). We ran deterministic and probabilistic uncertainty analyses and estimated the probability that the vaccine would be cost-effective at a threshold set at 0.7 times the national gross domestic product (GDP) per capita.

A decade of vaccination in Jordan could prevent at least 2200 cervical cancer cases and 1200 deaths (a reduction of over 50%) over the lifetimes of the vaccinated girls. The program costs associated with introducing Cecolin® ($2.90 per dose) were $9.2 million, but this was offset by around $14.6 million in treatment cost savings (Cecolin® was cost-saving in 97% of the probabilistic runs). Cervarix™ ($10.25 per dose) was estimated to cost $16.2 million but had greater health benefits than Cecolin® (68% versus 55% impact). Compared to Cecolin® each additional DALY averted by Cervarix™ would cost $2025. Cervarix™ had a 100% probability of being cost-effective at a threshold of 0.7 times the national GDP per capita) when compared directly to Cecolin®. Gardasil® ($13.50 per dose) was dominated/removed because it generated equivalent or lower health benefits to the other products at higher cost. The results were robust to changes in key input parameters.

A single dose of Cecolin® could prevent more than half of the expected lifetime cervical cancer cases and deaths in Jordan and is very likely to be cost saving. Cervarix™ may be more impactful than Cecolin® but this depends on cross-protection assumptions. Continued multi-sectoral engagement and donor collaboration will be essential to ensure sustainable integration into the national immunization programme.