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Vaccine. 2014 Oct 7;32(44):5845-53. doi: 10.1016/j.vaccine.2014.07.099. Epub 2014 Aug 12.

Comparing the cost-effectiveness of two- and three-dose schedules of human papillomavirus vaccination: a transmission-dynamic modelling study.

Author information

1
Centre de recherche du CHU de Québec, Québec, Canada.
2
Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada.
3
Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
4
Modelling and Economics Unit, Public Health England, United Kingdom; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
5
Division of Cancer Epidemiology, McGill University, Montreal, Canada.
6
Centre de recherche du CHU de Québec, Québec, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom. Electronic address: marc.brisson@uresp.ulaval.ca.

Abstract

BACKGROUND:

Recent evidence suggests that two doses of HPV vaccines may be as protective as three doses in the short-term. We estimated the incremental cost-effectiveness of two- and three-dose schedules of girls-only and girls & boys HPV vaccination programmes in Canada.

METHODS:

We used HPV-ADVISE, an individual-based transmission-dynamic model of multi-type HPV infection and diseases (anogenital warts, and cancers of the cervix, vulva, vagina, anus, penis and oropharynx). We conducted the analysis from the health payer perspective, with a 70-year time horizon and 3% discount rate, and performed extensive sensitivity analyses, including duration of vaccine protection and vaccine cost.

FINDINGS:

Assuming 80% coverage and a vaccine cost per dose of $85, two-dose girls-only vaccination (vs. no vaccination) produced cost/quality-adjusted life-year (QALY)-gained varying between $7900-24,300. The incremental cost-effectiveness ratio of giving the third dose to girls (vs. two doses) was below $40,000/QALY-gained when: (i) three doses provide longer protection than two doses and (ii) two-dose protection was shorter than 30 years. Vaccinating boys (with two or three doses) was not cost-effective (vs. girls-only vaccination) under most scenarios investigated.

INTERPRETATION:

Two-dose HPV vaccination is likely to be cost-effective if its duration of protection is at least 10 years. A third dose of HPV vaccine is unlikely to be cost-effective if two-dose duration of protection is longer than 30 years. Finally, two-dose girls & boys HPV vaccination is unlikely to be cost-effective unless the cost per dose for boys is substantially lower than the cost for girls.

KEYWORDS:

Anogenital warts; Cervical cancer; Cost-effectiveness; Human papillomavirus (HPV); Immunisation; Programme optimisation; Transmission-dynamic modelling; Vaccine schedules

PMID:
25131743
DOI:
10.1016/j.vaccine.2014.07.099
[Indexed for MEDLINE]
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