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Cost-effectiveness of human papillomavirus vaccination in Belgium: Do not forget about cervical cancer screening

  • Nancy Thiry (a1), Chris De Laet (a1), Frank Hulstaert (a1), Mattias Neyt (a1), Michel Huybrechts (a1) and Irina Cleemput (a1)...
Abstract

Objectives: The cost-effectiveness of adding a human papillomavirus (HPV) vaccination program in 12-year-old females to the recommended cervical cancer screening in Belgium is examined. Moreover, the health and economic consequences of a potential decline in screening uptake after initiation of a HPV vaccination program are investigated.

Methods: A static Markov model is developed to estimate the direct effect of vaccination on precancerous lesions and cervical cancers.

Results: Vaccination is estimated to avoid 20 percent of the cervical cancers occurring in a 12-year-old girls' cohort and to cost €32,665 per quality-adjusted life-year (QALY) gained (95 percent credibility interval [CrI]: €17,447 to €68,078), assuming a booster injection after 10 years, a limited duration of protection and discounting costs and effects at 3 percent and 1.5 percent, respectively. Assuming lifelong protection, HPV vaccination is estimated to cost €14,382 (95 percent CrI: €9,238 to €25,644) per QALY gained, while avoiding 50 percent of the cervical cancer cases. In the base-case, a 10 percent reduction in screening compliance after vaccination obliterates the effect of vaccination on cervical cancer cases avoided, whereas further declines in the level of screening compliance even turned out to be detrimental for the cohort's health, inducing a mean loss in QALYs and life-year gained compared with the situation prevaccination.

Conclusions: An HPV vaccination program should only be considered if the level of screening after vaccination can be maintained.

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8.HJ Boot , I Wallenburg , HE de Melker , Assessing the introduction of universal human papillomavirus vaccination for preadolescent girls in The Netherlands. Vaccine. 2007;25:62456256.

9.M Brisson , WJ Edmunds . Economic evaluation of vaccination programs: The impact of herd-immunity. Med Decis Making. 2003;23:7682.

10.M Brisson , N Van de Velde , P De Wals , M-C Boily . The potential cost-effectiveness of prophylactic human papillomavirus vaccines in Canada. Vaccine. 2007;25:53995408.

12.HW Chesson , DU Ekwueme , M Saraiya , LE Markowitz . Cost-effectiveness of human papillomavirus vaccination in the United States. Emerg Infect Dis. 2008;14:244251.

18.EH Elbasha , EJ Dasbach , RP Insinga . Model for assessing human papillomavirus vaccination strategies. Emerg Infect Dis. 2007;13:2841.

19.C Fraser , JE Tomassini , L Xi , Modeling the long-term antibody response of a human papillomavirus (HPV) virus-like particle (VLP) type 16 prophylactic vaccine. Vaccine. 2007;25:43244333.

20.Future II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:19151927.

21.SM Garland , M Hernandez-Avila , CM Wheeler , Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007;356:19281943.

22.SJ Goldie , M Kohli , D Grima , Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst. 2004;96:604615.

23.DM Harper , EL Franco , C Wheeler , Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: A randomised controlled trial. Lancet. 2004;364:17571765.

26.S Kulasingam , L Connelly , E Conway , A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007;4:165175.

27.SL Kulasingam , ER Myers . Potential health and economic impact of adding a human papillomavirus vaccine to screening programs. JAMA. 2003;290:781789.

31.N Munoz , FX Bosch , X Castellsague , Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer. 2004;111:278285.

32.ER Myers , DC McCrory , K Nanda , L Bastian , DB Matchar . Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol. 2000;151:11581171.

33.K Nanda , DC McCrory , ER Myers , Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review. Ann Intern Med. 2000;132:810819.

35.AT Newall , P Beutels , JG Wood , WJ Edmunds , CR MacIntyre . Cost-effectiveness analyses of human papillomavirus vaccination. Lancet Infect Dis. 2007;7:289296.

36.GD Sanders , AV Taira . Cost-effectiveness of a potential vaccine for human papillomavirus. Emerg Infect Dis. 2003;9:3748.

37.K Sigurdsson , F Taddeo , K Benediktsdottir , HPV genotypes in CIN 2–3 lesions and cervical cancer: A population-based study. Int J Cancer. 2007;121:26822687.

38.JS Smith , L Lindsay , B Hoots , Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. Int J Cancer. 2007;121:621632.

40.AV Taira , CP Neukermans , GD Sanders . Evaluating human papillomavirus vaccination programs. Emerg Infect Dis. 2004;10:19151923.

44.GJ van Oortmarssen , JD Habbema , M van Ballegooijen . Predicting mortality from cervical cancer after negative smear test results. BMJ. 1992;305:449451.

45.LL Villa , RLR Costa , CA Petta , High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer. 2006;95:14591466.

46.CBJ Woodman , SI Collins , LS Young . The natural history of cervical HPV infection: Unresolved issues. Nat Rev Cancer. 2007;7:1122.

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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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