Abstract
BackgroundVaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The role of protection against non-HPV-16/18 was also investigated. MethodsA published Markov cohort model was adapted to Belgium. The model replicated the natural history of HPV infection, the effects of screening, and vaccination. Vaccine efficacy (VE) included non-HPV-16/18 protection based on the PATRICIA clinical trial data. Pre- and post-HPV exposure VE were differentiated. Lifetime vaccine protection was assumed. Input data were obtained from literature review, national databases and a Delphi panel. Costing was from a healthcare payer perspective. Costs were discounted at 3% and effects at 1.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. The specific effect of non-HPV-16/18 protection was investigated. Univariate sensitivity analysis was performed on key variables. ResultsThe model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of €9171/QALY. Vaccinating at age 26 would prevent 340 CC cases (40 non-HPV-16/18) with an ICER of €17,348/QALY and vaccinating at age 40 would prevent 146 CC cases (17 non-HPV-16/18) with an ICER of €42,847/QALY. The ICER remained under the highly cost-effective threshold (1×GDP/capita) until age 33 years and under the cost-effective threshold (3×GDP/capita) beyond age 40. ConclusionExtending HPV vaccination to females post-sexual debut could lead to a substantial reduction in CC-related burden and would be cost-effective in Belgium.
Highlights
Worldwide, cervical cancer is the third most common cancer in women [1]
The cervical cancer incidence modelled without vaccination fitted the reported age-dependent cervical cancer incidence observed in Belgium between 2001 and 2003
As age at vaccination increased the number of cases of cervical cancer avoided and the cost-effectiveness of vaccination decreased (ICER increased)
Summary
Cervical cancer is the third most common cancer in women [1]. screening can reduce the incidence of and mortality from cervical cancer, by detecting and allowing treatmentAbbreviations: CC, cervical cancer; CIN, cervical intraepithelial neoplasia; CIS, carcinoma in situ; GDP, gross domestic product; HPV, human papillomavirus; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; TVC, total vaccinated cohort; VE, vaccine efficacy.of pre-cancerous changes, cervical cancer remains an important public health problem in Europe, with an estimated 31,000 cases and 14,000 deaths in 2004 [2]. Vaccination against human papillomavirus (HPV) to prevent cervical cancer (CC) primarily targets young girls before sexual debut and is cost-effective. We assessed whether vaccination with the HPV-16/18 AS04-adjuvanted vaccine added to screening remains cost-effective in females after sexual debut compared to screening alone in Belgium. The incremental cost-effectiveness ratio (ICER) per qualityadjusted life-year (QALY) gained and the number of lesions prevented with vaccination from age 12 to 40 was evaluated. Results: The model estimated that vaccinating a cohort of 100,000 girls at age 12 would prevent 646 CC cases over a lifetime (102 non-HPV-16/18) with an ICER of D 9171/QALY.
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