Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage

Autor: Terje Raud, Lee Padrik, Triin Võrno, Rainer Reile, Raul-Allan Kiivet, Oliver Nahkur, Anneli Uusküla, Katrin Lutsar
Rok vydání: 2017
Předmět:
Adult
Estonia
medicine.medical_specialty
Pediatrics
Vaginal Neoplasms
Adolescent
Cost effectiveness
Cost-Benefit Analysis
Population
Uterine Cervical Neoplasms
Genital warts
Young Adult
03 medical and health sciences
0302 clinical medicine
Humans
Medicine
Anal cancer
Papillomavirus Vaccines
030212 general & internal medicine
Child
education
health care economics and organizations
Aged
Aged
80 and over
Gynecology
Cervical cancer
education.field_of_study
Models
Statistical
General Veterinary
General Immunology and Microbiology
business.industry
Incidence
Papillomavirus Infections
Public Health
Environmental and Occupational Health
HPV infection
Middle Aged
Anus Neoplasms
medicine.disease
Vaccination
Oropharyngeal Neoplasms
Regimen
Infectious Diseases
030220 oncology & carcinogenesis
Molecular Medicine
Female
Mouth Neoplasms
business
Zdroj: Vaccine. 35:6329-6335
ISSN: 0264-410X
Popis: Background Estonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening. Methods A Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN 1–3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88 years (up to 100 years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%. Results Vaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367–21,711, €5142–21,800 and €4563–18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage. Conclusion Vaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine used.
Databáze: OpenAIRE
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