HPV16/18 vaccination to prevent cervical cancer in The Netherlands: Model‐based cost‐effectiveness

Abstract

We evaluated the cost-effectiveness of HPV16/18 vaccination for girls aged 12 years in The Netherlands in addition to cervical cancer screening. For this purpose, we developed a simulation model that describes the relation between each of the high-risk human papillomavirus (hrHPV) types and cervical disease, allowing the occurrence of multiple type-specific infections. Model parameters were derived from Dutch cohort studies, including a large population-based screening trial, and from the national cervical cancer registry. The model satisfactorily reproduced Dutch data on HPV infection and the presence of cervical lesions. For our base-case scenario in which 85% of the girls aged 12 years were vaccinated against types 16/18 (95% efficacy, lifelong protection), the model predicted a decrease of 60% in the number of cervical cancer cases and cervical cancer deaths indicating that substantial health benefits can be achieved. Health savings were robust against changes in the vaccine efficacy (varied from 85% to 98%) but savings showed a substantial reduction when the efficacy started waning 10 years after vaccination. The discounted costs per qualityadjusted life year (QALY) were € 19,500/QALY (range € 11,000 to € 25,000/QALY) and lied near the cost-effectiveness threshold of € 20,000/QALY used in The Netherlands. The simulations further showed that vaccination cannot replace screening because vaccination without screening was less effective than screening in preventing cancer in women over 40 years of age. In conclusion, our model results support the implementation of HPV16/18 vaccination in young women in addition to cervical cancer screening. ' 2008 Wiley-Liss, Inc.Key words: simulation model; human papillomavirus; cervical cancer; vaccination Infection with high-risk human papillomavirus (hrHPV) is the necessary cause of cervical cancer.1 Recently, prophylactic vaccines have come available that protect against infection with the oncogenic HPV types 16 and 18.2,3 HPV 16 and/or 18 (HPV 16/ 18) is present in 60-80% of all cervical cancer cases.4,5 Therefore, mass vaccination may have a substantial impact on the burden of cervical cancer, even in countries with organized cervical screening. The safety and efficacy of HPV16/18 vaccination has been demonstrated in several large randomized trials. 3,6,7 For women without detectable HPV16/18 DNA, an efficacy of 90-98% against HPV16/18 positive cervical intraepithelial neoplasia grade 2 and 3 (CIN2/3) was reported. In addition, some evidence for cross-protection against other HPV types was reported.3 Because of the limited follow-up, long-term efficacy is still uncertain but within the first 5 years no reduction in efficacy was observed and HPV type-specific antibody levels remained at a high level. 8To decide whether or not to introduce nationwide HPV16/18 vaccination, insight into the cost-effectiveness of vaccination is needed in addition to information on safety and efficacy. For this purpose, simulation models have been developed that predict country-specific costs...

Cost-effectiveness analysis of Human Papillomavirus (HPV) Vaccination in the Netherlands: Recent publication reinforces favorable cost-effectiveness despite misleading conclusion

“…As the design of the model by de Kok et al is comparable to that published by other research groups that estimated cost-effectiveness of HPV vaccination [1,2,14], comparable costeffectiveness ratios from these analyses would be expected. Indeed, if the only relevant ratio from de Kok et al at D 19,700 would be taken, the similarity is striking.…”

“…I conclude that the conclusion by de Kok et al is misleading, should be re-visited and would probably better be formulated as "In the Netherlands, HPV vaccination is likely to be cost-effective if compared with screening alone", and that is fully in line what other studies -with 2 of them in Vaccinerecently found [1,2,14].…”

Economic evaluation of human papilloma virus vaccination in the European Union: a critical review

“…Thirty-six articles including EEs focused on HPV vaccination strategies were considered eligible for analysis; 20 were then excluded, as they referred to non-EU settings. Therefore, 16 articles [18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] were eligible. One of them lacked essential methodological transparency [20], so 15 were eventually selected comprising 24 EEs since 9 articles [21, 23-26, 30, 32-34] contained two separate analyses.…”

Cost-effectiveness analysis of various pertussis vaccination strategies primarily aimed at protecting infants in the Netherlands

“…64 Based on a recently published cost-effectiveness analysis of vaccination against human papillomavirus, the vaccine administration cost was assumed at €6.00 ($8.40). 65 Thus, the total immunization cost of a new pertussis vaccination strategy was assumed to be €24.30 ($33.40) per dose. For the at-birth immunization strategy, vaccination costs might be lower because midwives are already present during birth and administration might be relatively easy.…”