PCN13 Analysis of the Impact of Prophylactic Vaccination Against Human Papillomavirus Infection Using a Dynamic-Modelling Approach

Abstract

OBJECTIVES: Since 2008, teenage girls are being vaccinated against Human Papillomavirus (HPV) in Europe. The vaccine coverage did not reach high uptake. The aim of this study is to design a dynamic transmission framework to model HPVtransmission in the population in order to predict epidemiologic and economic consequences of population-based HPV vaccination programs. METHODS: A dynamic transmission model was designed including 7 different HPV-types to predict the epidemiologic and economic consequences of HPV-vaccination. Dutch agespecific HPV-prevalence and cervical cancer incidence and mortality data were used to calibrate the model assuming a steady state. The consequence of HPVvaccination was analyzed in different scenarios. In particular, the age of the vaccinee, inclusion of boys, and a reduced screening compliance was assessed. In sensitivity analyses, the vaccination coverage, duration of vaccine-induced protection, and vaccine choice was varied. RESULTS: Vaccination of 50% of girls against HPV infection results in a 56% overall reduction in cervical cancer incidence. The model predicted outcomes are highly sensitive for the duration of vaccine-induced protection and the vaccination coverage. If vaccination will only provide 20-years of protection a 32% reduction in cervical cancer incidence was observed. HPV16 and 18 will be eradicated from the general population if vaccine coverage is >90%. Vaccination at an older age still provides a relevant number of cases averted however vaccination before sexual debut remains most efficient. Vaccination of boys was found to be not an effective alternative. CONCLUSIONS: HPV vaccination was found to be highly effective in reducing the burden of cervical cancer. The model predicted outcomes are most sensitive for vaccine-induced duration of protection. Vaccination of girls at an older age can be considered to further reduce the incidence of cervical cancer.