National cervical cancer prevention program in the Arab States: Strategies and cost-minimization study of the Tunisian case.

BACKGROUND: The Arab states geographic region is marked by a low to moderate cervical cancer screening coverage rates and the absence of national human papillomavirus (HPV) vaccination programs, except for the United Arab Emirates. Knowing that the HPV prevalence among Tunisian woman is estimated to 4.9/100 000 according to the "HPV Center" data, this study aims to estimate the cost of a national cervical cancer prevention program in Tunisia using either the primary prevention method (the two-dose schedule anti-HPV vaccine according to the WHO recommendation for young adolescents) or the secondary prevention method (the Pap smear test according to three time-lapse periodicity).

METHODS: The mean incremental cost of one avoided cervical cancer case was calculated for each prevention scenario.

RESULTS: The ascending incremental costs by avoided cervical cancer case are: 1- the national vaccination program through the GAVI support ($ 1803), 2- the cervical cancer screening according to 10-year periodicity ($ 8219), 3- the cervical cancer screening according to 5-year periodicity ($ 14,567), 4- the cervical cancer screening according to 3-year periodicity ($ 20,479), 5- and finally the national vaccination program according to the manufacturer marketed price ($ 36,854).

CONCLUSION: Currently, the anti-HPV national vaccination program combined with cervical cancer screening according to 5-year periodicity present the best cost-effective strategy for cervical cancer prevention in Tunisia. This study gives Tunisian decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the cervical cancer prevention strategies.