BACKGROUND: Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated. METHODS: A published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables. RESULTS: The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40. CONCLUSION: Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.
BACKGROUND: Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated. METHODS: A published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables. RESULTS: The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40. CONCLUSION: Extending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.
Authors: F Xavier Bosch; Claudia Robles; Mireia Díaz; Marc Arbyn; Iacopo Baussano; Christine Clavel; Guglielmo Ronco; Joakim Dillner; Matti Lehtinen; Karl-Ulrich Petry; Mario Poljak; Susanne K Kjaer; Chris J L M Meijer; Suzanne M Garland; Jorge Salmerón; Xavier Castellsagué; Laia Bruni; Silvia de Sanjosé; Jack Cuzick Journal: Nat Rev Clin Oncol Date: 2015-09-01 Impact factor: 66.675
Authors: J Ananworanich; W Prasitsuebsai; S J Kerr; R Hansudewechakul; N Teeratakulpisarn; K Saisawat; R Ramautarsing; J Achalapong; K Pussadee; S Keadpudsa; T Mackay; T Pankam; P Rodbamrung; W Petdachai; K Chokephaibulkit; A H Sohn; N Phanuphak Journal: J Virus Erad Date: 2015-01
Authors: Ariel Esteban Bardach; Osvaldo Ulises Garay; María Calderón; Andrés Pichón-Riviére; Federico Augustovski; Sebastián García Martí; Paula Cortiñas; Marino Gonzalez; Laura T Naranjo; Jorge Alberto Gomez; Joaquín Enzo Caporale Journal: BMC Public Health Date: 2017-02-02 Impact factor: 3.295
Authors: Paolo Bonanni; Giovanni Gabutti; Nadia Demarteau; Sara Boccalini; Giuseppe La Torre Journal: BMC Infect Dis Date: 2015-09-17 Impact factor: 3.090