Modelling the economic value of cross- and sustained-protection in vaccines against cervical cancer

Abstract

Objective: Two human papillomavirus (HPV) vaccines are on the market. Based on expected differences in sustained- and cross-protection between the two vaccines, their long-term economic value is modelled and compared for France, Ireland and Italy.Methods: A Markov cohort model reproducing the natural history of HPV infections, screening and vaccination, is adapted to country-specific data. Two hypothetical HPV vaccines (VA and VB) are compared. At baseline VA provides lifetime protection against HPV‐16 and 10-year protection against HPV‐18 before waning. VB is the same as VA with a 10-year protection against HPV‐6 and 11. Sustained- and cross-protection is varied over wide ranges in VA to define the levels that could make VA cost-effective or dominant compared with VB.Results: Under baseline conditions VB dominates VA. VA becomes cost-effective when the difference in cross-protection alone reaches 13–15% (undiscounted), and 22–44% (discounted). A combination of sustained- and cross-protection is required for VA to dominate VB (discounted). The results are dependent upon country, the base-case value and the discount applied.Conclusion: Realistic additional sustained- and cross-protection in one HPV vaccine may confer benefits that offset the economic value of protection against low-risk HPV in the other. The results are country specific.