Projecting the Health and Economic Impact of a Quadrivalent HPV Vaccine using a Multi-type Transmission Dynamic Model
- Presenter:
Chair: Dave Vanness; Discussant: David Vanness Mon June 5, 2006 15:30-17:00 Room 235
Background: The health and economic burden of HPV disease is significant. A safe, efficacious, prophylactic quadrivalent HPV (6/11/16/18) vaccine that reduces the overall incidence of cervical cancer, cervical intraepithelial neoplasias (CIN), genital warts, and HPV infection may soon be available. Objectives: To assess the cost-effectiveness of alternative HPV vaccination strategies (i.e., routine vaccination of 12-year old females versus 12-year old females and males) in settings with established cervical cancer screening programs in the U.S.
Methods: A non-linear, deterministic, age-structured, mathematical model of the transmission dynamics of HPV and cancer development in a U.S. population stratified by sex and sexual activity was developed and integrated with an economic model that accounts for the effectiveness and economic consequences of vaccination strategies. Inputs for the model were obtained from public data sources, published literature, and clinical trials. We assumed a vaccine uptake of 70%. We varied duration of protection from 10 years to lifetime and the cost of the vaccination series from $300-$500.
Results: Assuming lifetime duration of protection, vaccination combined with screening reduced the prevalence of high risk HPV by 60% and the incidence of genital warts, CIN, and cervical cancer by 76%, 43%, and 44% respectively after 100 years. The incremental cost-effectiveness ratios ranged from cost-saving to ~$124,000 per quality adjusted life year gained. The following parameters exerted the greatest influence on the results: vaccine characteristics of degree and duration of protection, preference weights, and cost of vaccination. Conclusion: Vaccination with a prophylactic quadrivalent HPV vaccine can reduce the incidence of cervical cancer, CIN, and genital warts and provide survival benefits and quality of life improvements at a cost within the range accepted as cost-effective for a reasonably wide range of model input values.
