Article Text

Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries
  1. Jessica Ochalek1,
  2. Kaja Abbas2,
  3. Karl Claxton1,
  4. Mark Jit2,3,4,
  5. James Lomas1
  1. 1Centre for Health Economics, University of York, York, United Kingdom
  2. 2Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
  3. 3Modelling and Economics Unit, Public Health England, London, United Kingdom
  4. 4School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
  1. Correspondence to Jessica Ochalek; jessica.ochalek{at}


Introduction Estimating the value of providing effective healthcare interventions in a country requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other healthcare activities in that country. This potential alternative use of the same resources represents the health opportunity cost of providing the intervention. Without such assessments, there is a danger that blanket recommendations made by international organisations will lead to the adoption of healthcare interventions that are not cost effective in some countries, even given existing donor mechanisms intended to support their affordability.

Methods We assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO’s proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices.

Results At Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries.

Conclusion Estimates of the net health impact of providing a healthcare intervention can be used to assess the benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions.

  • health economics
  • vaccines

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Handling editor Lei Si

  • Contributors JO undertook the analysis and wrote the initial draft. KA, KC, MJ and JL contributed equally to developing the analysis plan, the review and interpretation of results and the final drafting of the manuscript.

  • Funding This study is funded by Vaccine Impact Modelling Consortium (OPP1157270), Bill and Melinda Gates Foundation (OPP1165566).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data on the costs and benefits of HPV vaccination across countries are output from the PRIME Tool, which can be accessed at Country-specific estimates of the health effects of changes in health care expenditure can be accessed at

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.