Abstract
The objective of these analyses is to assess the epidemiologic (cervical cancer [CC], cervical intraepithelial neoplasia [CIN], and genital warts [GW]) and economic impact of quadrivalent (6/11/16/18) HPV vaccination in 9-10 year-old females at higher vaccine coverage rates (VCRs) than currently observed in Colombia. A published dynamic HPV disease transmission model that accounts for herd protection effects with a 100-year time horizon was calibrated to estimate epidemiological impact and cost utility of increasing the VCR from 35% to 50% and 80%. The discount rate applied for costs and health outcomes was 3%. Colombian specific data were used for calibration. Over 100 years, increasing VCR to 50% showed a reduction in disease incidence in females compared with the current program: CC (6.1%; 14,868 cases), HPV16/18-related CIN-1 (7.8%; 197,500 cases), CIN-2/3 (7.6%; 484,612 cases), HPV6/11-related CIN-1 (5.5%, 69,985 cases), and GW (6.4%; 1,351,382 cases), and in males: GW (3.4%; 814,236 cases). At a higher VCR (80%), the model showed a reduction in the disease incidence in females: CC (17.1%; 42,906 cases), HPV16/18-related CIN-1 (22.5%; 572,907 cases), CIN-2/3 (22.2%; 1,404,672 cases), HPV6/11-related CIN-1 (16.4%, 209,721 cases), and GW (19.0%; 3,983,576 cases), and in males: GW (10.4%; 2,474,263 cases). The disease management cost savings (cost of vaccination – disease costs avoided) at 50% VCR and 80% VCR were USD$65,403,069 and USD$188,463,623, respectively, over 100 years. The two strategies proved to be cost savings with strongly dominating ICERs. In Colombia, increasing VCR of quadrivalent HPV vaccination would result in important incremental epidemiological and economic cost savings. These findings are conservative given that other HPV-related cancers in males and females and indirect costs were not considered; their inclusion would likely increase the estimated cost-savings.
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