Abstract
Assess clinical and economic outcomes of vaccination (Va) with human papillomavirus (HPV) 16/18 AS04-adjuvanted vaccine (16/18Vac) added to screening programmes (Scr) in cervical cancer (CC) prevention, from the National Healthcare System perspective. A lifetime Markov cohort model with yearly cycles was populated using national epidemiological, cost and treatment data to simulate the natural history of HPV and assess the effect of Va+Scr strategies versus Scr alone. Base case considers vaccinating a cohort of 206.788 girls aged 11, 80% of vaccine coverage and screening each 3 years from age 25 to 65. Efficacy of 16/18Vac was 95% against HPV-16/18 and cross-protection against 5 oncogenic non-vaccine types of 68%. Outcomes measured were number of CC cases, CC deaths, quality adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) between both strategies. The model also tested a broader campaign vaccinating both 11 & 18 years old during 7 years (100,000 individuals per cohort and year) versus vaccination girls aged 11 only. A discount rate of 3% over costs and outcomes was applied. Sensitivity analyses were performed to assess influence of different parameters. Base case scenario would avoid 817 CC cases and 188 deaths (undiscounted) versus Scr alone and generate 1,018 additional QALYs, resulting in an ICER of € 29.295/QALY (discounted). Vaccination of the cohorts aged 11 & 18 would avoid 2,448 CC cases and 602 CC deaths (undiscounted) compared with vaccination only of the 11 years cohort, and represents an ICER of 28,931€/QALY (discounted). Sensitivity analysis shows more favourable cost-effectiveness with higher coverage. HPV vaccination with 16/18Vac added to current screening programmes in Spain is a cost-effective strategy. More favourable cost-effectiveness results may be obtained by expanding vaccination to 18 years old women and increasing vaccination coverage. Results are in accordance with other studies published at national level.
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