Abstract
BackgroundIn Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. However, it has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer. This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination.MethodsThe present analysis used an existing static Markov model to assess the effect of screening and vaccination. This analysis includes the epidemiology of low-risk HPV types allowing for the comparison between the two vaccines (HPV-16/18 AS04-adjuvanted vaccine and the HPV-6/11/16/18 vaccine), latest cross-protection data on HPV vaccines, treatment costs for cervical cancer, vaccine costs and 6% discounting per the health economic guideline for Chile.ResultsProjected incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICERs) for the HPV-16/18 AS04-adjuvanted vaccine was 116 United States (US) dollars per quality-adjusted life years (QALY) gained or 147 US dollars per life-years (LY) saved, while the projected ICUR/ICER for the HPV-6/11/16/18 vaccine was 541 US dollars per QALY gained or 726 US dollars per LY saved. Introduction of any HPV vaccine to the present cervical cancer prevention program of Chile is estimated to be highly cost-effective (below 1X gross domestic product [GDP] per capita, 14278 US dollars). In Chile, the addition of HPV-16/18 AS04-adjuvanted vaccine to the existing screening program dominated the addition of HPV-6/11/16/18 vaccine. In the probabilistic sensitivity analysis results show that the HPV-16/18 AS04-adjuvanted vaccine is expected to be dominant and cost-saving in 69.3% and 77.6% of the replicates respectively.ConclusionsThe findings indicate that the addition of any HPV vaccine to the current cervical screening program of Chile will be advantageous. However, this cost-effectiveness model shows that the HPV-16/18 AS04-adjuvanted vaccine dominated the HPV-6/11/16/18 vaccine. Beyond the context of Chile, the data from this modelling exercise may support healthcare policy and decision-making pertaining to introduction of HPV vaccination in similar resource settings in the region.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1222) contains supplementary material, which is available to authorized users.
Highlights
In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program
The model was previously evaluated in terms of its capacity, requirements, limitations and comparability in a study conducted by the World Health Organization [16] and has been extended by including infection with low-risk human papillomavirus (HPV) types that might lead to the development of a cervical intraepithelial neoplasia (CIN) grade 1 (CIN1) lesion and genital warts (GW) [17]
Base case analyses The model was validated by comparing modelled outcomes with published epidemiological parameters for Chile which were obtained from the latest local epidemiological data [10,35,36]
Summary
In Chile, significant reductions in cervical cancer incidence and mortality have been observed due to implementation of a well-organized screening program. It has been suggested that the inclusion of human papillomavirus (HPV) vaccination for young adolescent women may be the best prospect to further reduce the burden of cervical cancer This cost-effectiveness study comparing two available HPV vaccines in Chile was performed to support decision making on the implementation of universal HPV vaccination. Very few countries from the LAC region have shown a slight decrease in cervical cancer disease burden following implementation of screening programmes [4,5]. This may be due in part to difficulties in the implementation of organized screening programs in these low-resource settings. In most of the other countries in the LAC region where no screening programs exist, the incidence and mortality associated with cervical cancer remain high [1]
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