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J Med Econ. 2010;13(2):324-38. doi: 10.3111/13696998.2010.490481.

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

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Health Economics, GlaxoSmithKline Biologicals, Av. Fleming 20, Wavre, Belgium.



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.


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.


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.


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.

[Indexed for MEDLINE]

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