A cost–utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme

Dee, Anne; Howell, Fenton

doi:10.1093/eurpub/ckp141

Cited by 35 publications

(30 citation statements)

References 30 publications

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“…On the other hand, in developed countries that have been able to control CC incidence and mortality with solid preventive programs, the HPV vaccine is not as favorable from a cost-effectiveness point of view. Ireland, 20 Switzerland, 21 the United Kingdom, 22 and Finland 23 have gross CC incidence rates of less than 10 cases per 100,000 women/year. In these countries, costeffectiveness studies demonstrated an additional cost of more than US$20,000/QALY.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil

Fonseca

Ferreira

2014

Human Vaccines & Immunotherapeutics

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Section: Discussionmentioning

confidence: 99%

Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil

Fonseca

Ferreira

2014

Human Vaccines & Immunotherapeutics

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“…Ireland, Switzerland, the United Kingdom and Finland have gross CC incidence rates of less than 10 cases per 100,000 women per year [23][24][25][26]. In these countries, costeffectiveness studies demonstrated an additional cost of more than US$20 thousand to save one QALY.…”

Section: Strategiesmentioning

confidence: 99%

Cost-Effectiveness of Primary and Secondary Prevention Strategies for Cervical Cancer in Brazil: A Systematic Review

Fonseca¹

2013

Gynecol Obstet

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BackgroundAlthough Cervical Cancer (CC) can be effectively prevented, almost 500,000 new cases are diagnosed each year worldwide [1]. The global reduction in the incidence and mortality from CC over the last four decades did not occur in a homogeneous manner; it was concentrated in the developed countries that were able to implement solid and effective population screening programs [2].In Brazil, organizational and financial difficulties have compromised the quality of prevention programs based on Oncotic Cytology (OC), and they have not succeeded in controlling the disease ; approximately 17,500 new cases of CC are expected in 2013 [3][4][5]. It is the second most common type of neoplasia in women (excluding non-melanoma skin cancer), and it is the type of neoplasia that claims the most lives of young women (15 to 44 years of age) [1].These difficulties, which are associated with the inherent limitations of the OC technique, have led many researchers to seek alternative or supplementary techniques for OC for CC screening, such as the hybrid capture test (HPV-DNA), and, more recently, to prepare vaccines against the most carcinogenic genotypes of HPV. These new technologies exhibit better performance and/or effectiveness; however, they would result in higher costs if they were incorporated into Brazil's prevention strategy.Because of the universal increase in healthcare costs and the growing constraints imposed by the scarcity of resources, there is a greater need to justify the use of a new technique by considering its cost-effectiveness ratio [6]. To handle this growing demand, economic analysis tools can be applied to new healthcare technologies to support decision-making in public health that aims for rational and efficient use of available resources [7,8].Among the methods of economic evaluation, cost-effectiveness analyses have received special attention [7]. Markov models have been widely used to evaluate new technologies and to compare healthcare strategies around the world. In comparing two strategies, the Markovian model provides the Incremental Cost-Effectiveness Ratio (ICER) as the primary result [8]. This ratio shows the additional cost required to save 1 year of life (adjusted or not by quality of life) using one strategy compared to a baseline strategy. The World Health Organization stipulates that a strategy is considered cost-effective if the AbstractBackground: Although Cervical Cancer (CC) can be effectively prevented, it is still a serious public health problem, especially in developing countries. In Brazil, almost 18,000 new cases are expected in 2013, and it is the type of neoplasia that claims the most lives of young women. New secondary prevention strategies (such as the HPV-DNA test) and primary prevention strategies (vaccination against HPV) have been developed. However, applying these strategies to large populations is costly, and their use is limited in Brazil. Because financial resources are scarce in Brazilian scenario, studies about the economic implications of the new preventativ...

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“…Vaccination of early adolescent girls (aged 11 [19] or 12 years [20][21][22][23] ) with the AS04-adjuvanted HPV 16/18 vaccine was estimated to be cost effective relative to screening alone from a healthcare payer perspective in a number of countries. All analyses used lifetime cohort Markov models with a 1-year cycle length, evaluated direct costs from a healthcare provider perspective, assumed a protective efficacy of »95-98% against HPV types 16 and 18 with a lifetime duration of efficacy, and discounted both costs and benefits.…”

Section: Other Commentsmentioning

confidence: 99%

“…Most analyses also considered the effect of cross protection against other HPV genotypes. [19,20,22,23] The incremental costs per quality-adjusted life-year (QALY) were h17 294 in Finland (year of costing 2006), [19] h9706 in France (2007), [20] h30 460 in Ireland (not reported), [21] h22 055 in Italy (2007), [22] and $US7339 in Singapore (2008). [23] All incremental costs per QALY gained are lower than commonly accepted willingness-topay thresholds of »h30 000-50 000.…”

Section: Other Commentsmentioning

confidence: 99%

AS04-adjuvanted human papillomavirus types 16/18 vaccine (Cervarix®): a guide to its use

Lyseng‐Williamson

McKeage

2012

Drugs & Therapy Perspectives

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The AS04-adjuvanted human papillomavirus (HPV) 16/18 vaccine is indicated for the prevention of premalignant cervical lesions and cervical cancer causally related to certain oncogenic HPV types. The vaccine elicits a high immunogenic response and is highly protective against cervical intraepithelial neoplasia and infection. It is also generally well tolerated, and cost effective from a healthcare payer perspective.What is the rationale for the development of the vaccine?Human papillomavirus (HPV) infection of the genital region is highly contagious and is usually transmitted via sexual contact. [1] As a result, HPV infection is common among sexually active individuals, although most will clear the virus without developing clinical manifestations. In women who do not develop effective cell-mediated immunity, persistent cervical infection with oncogenic HPV, which is a precursor to precancerous lesions and cervical cancer, can result. [1] In addition to cervical screening programmes, national immunization programmes against oncogenic HPV types causally related to cervical cancer have recently been implemented in many countries to provide effective and longterm protection against HPV infection. [1] The two most common types of HPV are HPV 16 and HPV 18, which together account for »70% of all cases of cervical cancer; [2] other high-risk HPV types include 31, 33, 35, 45, 52 and 58. Currently available vaccines against HPV are the AS04-adjuvanted HPV 16/18 vaccine (Cervarix Ò ) targeted against HPV 16/18, and the quadrivalent HPV vaccine (Gardasil Ò ) targeted against HPV 6/11/16/18. HPV 6 and 11 are not usually linked with cancer, but are responsible for anogenital warts; therefore, the quadrivalent vaccines is also indicated to protect against external genital warts that are caused by specific HPV types in males and females. [1] Who should receive the vaccine?The AS04-adjuvanted HPV 16/18 vaccine is approved for use in females in many countries worldwide. In the EU, it is indicated for the prevention of premalignant cervical lesions and cervical cancer causally related to certain oncogenic HPV types in females aged ‡10 years. [2] Of note, the European Medicines Agency (EMA) recently adopted a positive opinion to extend the existing therapeutic indication to females aged ‡9 years. [3] Table I provides a brief summary of the EU prescribing information for the vaccine. [2] How does the vaccine work?The AS04-adjuvanted HPV 16/18 vaccine is produced using recombinant DNA technology, in which the vaccine is prepared from highly purified noninfectious virus-like particles (VLPs) of the major capsid L1 protein of oncogenic HPV types 16 and 18. [2] The VLPs induce a marked immunogenic response eliciting high levels of anti-L1 VLP antibodies that persist at levels considerably greater than those observed with natural infection. Following vaccination, neutralizing antibodies transude from serum into cervicovaginal secretions, where they may provide first-line defence against HPV. [4] Immune memory is also necessary for long-te...

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A cost–utility analysis of adding a bivalent or quadrivalent HPV vaccine to the Irish cervical screening programme

Abstract: HPV vaccination has the potential to be very cost effective in Ireland. The quadrivalent vaccine is more cost effective than the bivalent vaccine.

Cited by 35 publications

References 30 publications

Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil

Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil

Cost-Effectiveness of Primary and Secondary Prevention Strategies for Cervical Cancer in Brazil: A Systematic Review

AS04-adjuvanted human papillomavirus types 16/18 vaccine (Cervarix®): a guide to its use

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