Abstract
Human papillomavirus (HPV) infection, usually a sexually transmitted disease, is a risk factor for cervical cancer. Given the substantial disease and death associated with HPV and cervical cancer, development of a prophylactic HPV vaccine is a public health priority. We evaluated the cost-effectiveness of vaccinating adolescent girls for high-risk HPV infections relative to current practice. A vaccine with a 75% probability of immunity against high-risk HPV infection resulted in a life-expectancy gain of 2.8 days or 4.0 quality-adjusted life days at a cost of $246 relative to current practice (incremental cost effectiveness of $22,755/quality-adjusted life year [QALY]). If all 12-year-old girls currently living in the United States were vaccinated, >1,300 deaths from cervical cancer would be averted during their lifetimes. Vaccination of girls against high-risk HPV is relatively cost effective even when vaccine efficacy is low. If the vaccine efficacy rate is 35%, the cost effectiveness increases to $52,398/QALY. Although gains in life expectancy may be modest at the individual level, population benefits are substantial.
Highlights
Human papillomavirus (HPV) infection, usually a sexually transmitted disease, is a risk factor for cervical cancer
Model Validation We evaluated outcomes in the current practice arm of the model to ensure that they reflected the frequency of events from the Surveillance, Epidemiology and End Results (SEER) registry
Base-Case Analysis A prophylactic vaccine against high-risk HPV types is more expensive than current practice but results in greater quality-adjusted life expectancy (Table 1)
Summary
Human papillomavirus (HPV) infection, usually a sexually transmitted disease, is a risk factor for cervical cancer. Our model included probabilities of occurrence and progression of HPV, of squamous intraepithelial lesions (SIL), and of cervical cancer, as well as the probability of death, costs, and quality of life associated with the various health states. Each girl is at risk of developing high- or low-risk HPV, SIL, or cervical cancer. Based on the results of seven studies (N=1609), high-risk HPV infection was detected in 56% of women who had low-grade SIL, in 83% of women who had high-grade SIL, and in 90% of women who had cervical cancer.
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