Considering the commonly accepted threshold of euro50,000 per QALY, these analyses support the fact that adding a quadrivalent HPV vaccine to the current screening program in France is a cost-effective strategy for reducing the burden of cervical cancer, precancerous lesions, and genital warts caused by HPV types 6, 11, 16, and 18.

No abstract

Aim: Clinical trials have demonstrated the efficacy of the tetravalent human papillomavirus (HPV) vaccination in the prevention of cervical cancer and genital warts associated with HPV types 6, 11, 16 and 18. We used an empirically calibrated Markov cohort model of the natural history of HPV to assess the cost-effectiveness of the vaccine administered to 12-year-old girls alongside existing cervical screening programmes in Germany. Subjects and methods: The model estimated cervical cancer (CC), cervical intraepithelial neoplasia (CIN) and genital wart lifetime risks and total lifetime health care costs, life years gained and quality-adjusted life years (QALY) gained. The analysis was conducted from the perspective of the German health care payer. Results: In the base case (considering a lifetime duration of protection and 100% efficacy) it was estimated that 2,835 cervical cancer cases and 679 deaths could be prevented among a cohort of 400,000, at an incremental cost per QALY gained of 10,530 €. A total of 120 girls needed to be vaccinated to prevent 1 case of CC. Cost-effectiveness is sensitive to a duration of protection of less than 20 years and to the discount rate for costs and benefits. Conclusion: A policy of vaccinating adolescent girls has been recommended by the German Standing Committee on Vaccinations. This study has demonstrated that such a policy is cost-effective based on thresholds of cost-effectiveness that apply in Germany

with AIDS,4 though pathological studies show an even higher prevalence of a subacute encephalitis,5 which is believed to be due to HIV itself.6 Five to 10% of subjects also develop signs of damage to the peripheral nervous system,7 and at postmortem as many as 25% show signs of spinal cord disease.8 Controversy exists over the possibility that asymptomatic seropositive individuals might show subclinical evidence of evolving damage to either the central or peripheral nervous system. In particular it has been suggested that such individuals show impaired performance when subjected to a battery of neuropsychological tests.9 At the end of 1987 we therefore embarked upon a longitudinal study ofa cohort of seropositive and seronegative homosexual men, who underwent neurological, neurophysiological, and neuropsychological tests at six to nine month intervals. Annual recording of event related evoked potentials (P300s), central motor conduction times with magnetic stimulation, anid magnetic resonance imaging of the brain (MRI scanning) were added to the assessments at the second visit. This report of the cross sectional comparison of seropositive and seronegative subjects combines the clinical, neuropsychological, and neurophysiological data from the first visit and the MRI, magnetic stimulation, and P300 data collected for the first time at the second visit.

A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.