Inclusion of the benefits of enhanced cross-protection against cervical cancer and prevention of genital warts in the cost-effectiveness analysis of human papillomavirus vaccination in the Netherlands

BMC Infectious Diseases

Maarten J Postma¹  Jan C Wilschut³  Toos Daemen³  Hans W Nijman⁴  Edwin L de Vrij³  Eric D Tutuhatunewa³  Sara Dorsman²  Irina Stirbu-Wagner²  Tjalke A Westra³ 

[1] Health Economist, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands and Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;NIVEL Netherlands Institute of Health Service Research, Utrecht, The Netherlands;Department of Medical Microbiology, Molecular Virology Section, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands;Gynecologist-oncologist, Department of Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

关键词: Pricing of vaccines;    Cross-protection;    Genital warts;    Cost-effectiveness;    HPV-vaccination;    Cervical cancer;   

Others  :  1158429
DOI  :  10.1186/1471-2334-13-75

 received in 2012-05-22, accepted in 2013-01-25,  发布年份 2013

【 摘 要 】

Background

Infection with HPV 16 and 18, the major causative agents of cervical cancer, can be prevented through vaccination with a bivalent or quadrivalent vaccine. Both vaccines provide cross-protection against HPV-types not included in the vaccines. In particular, the bivalent vaccine provides additional protection against HPV 31, 33, and 45 and the quadrivalent vaccine against HPV31. The quadrivalent vaccine additionally protects against low-risk HPV type 6 and 11, responsible for most cases of genital warts. In this study, we made an analytical comparison of the two vaccines in terms of cost-effectiveness including the additional benefits of cross-protection and protection against genital warts in comparison with a screening-only strategy.

Methods

We used a Markov model, simulating the progression from HPV infection to cervical cancer or genital warts. The model was used to estimate the difference in future costs and health effects of both HPV-vaccines separately.

Results

In a cohort of 100,000 women, use of the bivalent or quadrivalent vaccine (both at 50% vaccination coverage) reduces the cervical cancer incidence by 221 and 207 cases, corresponding to ICERs of €17,600/QALY and €18,900/QALY, respectively. It was estimated that the quadrivalent vaccine additionally prevents 4390 cases of genital warts, reducing the ICER to €16,300/QALY. Assuming a comparable willingness to pay for cancer and genital warts prevention, the difference in ICERs could justify a slightly higher price (~7% per dose) in favor of the quadrivalent vaccine.

Conclusions

Clearly, HPV vaccination has been implemented for the prevention of cervical cancer. From this perspective, use of the bivalent HPV vaccine appears to be most effective and cost-effective. Including the benefits of prevention against genital warts, the ICER of the quadrivalent HPV vaccine was found to be slightly more favourable. However, current decision-making on the introduction of HPV is driven by the primary cervical cancer outcome. New vaccine tenders could consider the benefits of cross-protection and the benefits of genital warts, which requires more balanced decision-making.

【 授权许可】

   
2013 Westra et al.; licensee BioMed Central Ltd.

【 图 表 】

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