Cost-effectiveness analysis of HPV vaccination alongside cervical cancer screening programme in Slovenia

Abstract

The objective of the present study is to evaluate the cost-effectiveness of human papillomavirus (HPV) vaccination alongside cervical cancer screening programme in Slovenia. A previously published Markov model representing natural history of HPV infection was adapted to Slovenian context. The model followed a cohort of 12-year-old girls to 85-year-old women. Two strategies were compared: HPV vaccination alongside conventional cytological screening versus screening alone. Analysis was performed from the health care payer perspective. Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of 23,178 EUR per quality adjusted life-year (QALY) gained and 54,536 EUR per life-year gained (LYG) at the discounting rate of 5%. Sensitivity analyses demonstrated that the ICER was most sensitive to the need for booster dose and to different values of discount rates. In case the booster dose was assumed 10 years after initial vaccination, the ICER value was increased to 58,690 EUR per QALY. On the other hand, using lower values of discount rates than the base case 5% significantly reduced the ICER value. According to the cost-effectiveness thresholds of 30,000 EUR per QALY which was adopted by the Health Council in Slovenia, HPV vaccination alongside screening programme can be regarded as cost-effective. However, cost-effectiveness of HPV vaccination would become questionable in case a booster dose was needed to provide lifetime protection.