• Sue J Goldie, Jane J Kim, Katie Kobus, Jeremy D Goldhaber-Fiebert, Joshua Salomon, Meredith K H O'shea, Xavier Bosch F F, Silvia de Sanjosé, and Eduardo L Franco.
• Department of Health Policy and Management, Program in Health Decision Science, Harvard School of Public Health, 718 Huntington Avenue, 2nd Floor, Boston, MA 02115, United States of America. sgoldie@hsph.harvard.edu
• Vaccine. 2007 Aug 14; 25 (33): 6257-70.

AbstractWe use an empirically calibrated model to estimate the cost-effectiveness of cervical cancer prevention in Brazil, a country with a high cervical cancer burden. Assuming 70% coverage, HPV 16, 18 vaccination of adolescent girls is expected to reduce the lifetime risk of cancer by approximately 42.7% (range, 33.2-53.5%); screening three times per lifetime is expected to reduce risk by 21.9-30.7% depending on the screening test, and a combined approach of vaccination and screening is expected to reduce cancer risk by a mean of 60.8% (range, 52.8-70.1%). In Brazil; provided the cost per vaccinated woman is less than I$ 25, implying a per dose cost of approximately I$ 5, vaccination before age 12, followed by screening three times per lifetime between ages 35 and 45, would be considered very cost-effective using the country's per capita gross domestic product as a cost-effectiveness threshold. Assuming a coverage rate of 70%, this strategy would be expected to prevent approximately 100,000 cases of invasive cervical cancer over a 5-year period. Vaccination strategies identified as cost-effective may be unaffordable in countries with similar socioeconomic profiles as Brazil without assistance; these results can provide guidance to the global community by identifying health investments of highest priority and with the greatest promise.

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